Provider Demographics
NPI:1306194568
Name:MACLEOD, GAEL S (LMHC, CAP)
Entity Type:Individual
Prefix:
First Name:GAEL
Middle Name:S
Last Name:MACLEOD
Suffix:
Gender:F
Credentials:LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 W HORATIO ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3917
Mailing Address - Country:US
Mailing Address - Phone:813-288-8010
Mailing Address - Fax:813-288-8030
Practice Address - Street 1:3715 W HORATIO ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3917
Practice Address - Country:US
Practice Address - Phone:813-288-8010
Practice Address - Fax:813-288-8030
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2314L101YA0400X
FLMH6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)