Provider Demographics
NPI:1326134503
Name:ANDRUS, GAYLE RAE (MA LLP)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:RAE
Last Name:ANDRUS
Suffix:
Gender:F
Credentials:MA LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3351 CLAYSTONE ST SE
Mailing Address - Street 2:STE 212
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5781
Mailing Address - Country:US
Mailing Address - Phone:616-954-1992
Mailing Address - Fax:616-954-1998
Practice Address - Street 1:3351 CLAYSTONE ST SE
Practice Address - Street 2:STE 212
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5781
Practice Address - Country:US
Practice Address - Phone:616-954-1992
Practice Address - Fax:616-954-1998
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008489103T00000X
MI4704071605163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health