Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor |
NPI | 1003381468 |
---|---|
Provider Name | Rebecca Gage |
First Address | Kalamazoo, MI 49006-3731 |
Second Address | Kalamazoo, MI 49006-3731 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2018 |
Last Update Date | 11/10/2018 |