Provider Demographics
NPI:1083163091
Name:MERTES, GALE MARIE (BCBA)
Entity Type:Individual
Prefix:
First Name:GALE
Middle Name:MARIE
Last Name:MERTES
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3129 FORSYTHIA BLVD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-0410
Mailing Address - Country:US
Mailing Address - Phone:615-517-0510
Mailing Address - Fax:
Practice Address - Street 1:6189 LEHMAN DR STE 202
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5409
Practice Address - Country:US
Practice Address - Phone:719-266-1000
Practice Address - Fax:719-266-1011
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst