Provider Demographics
NPI:1114118833
Name:SEAL, GEARL C (CDS II, CDVC II)
Entity Type:Individual
Prefix:
First Name:GEARL
Middle Name:C
Last Name:SEAL
Suffix:
Gender:M
Credentials:CDS II, CDVC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 NE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-1925
Mailing Address - Country:US
Mailing Address - Phone:541-416-1095
Mailing Address - Fax:541-416-0991
Practice Address - Street 1:205 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1925
Practice Address - Country:US
Practice Address - Phone:541-416-1095
Practice Address - Fax:541-416-0991
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YA0400X
INA21377101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional