Provider Demographics
NPI:1326776451
Name:FOUCHEY, GERALD STANLEY JR (MA)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:STANLEY
Last Name:FOUCHEY
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1317 LAUREL VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9411
Mailing Address - Country:US
Mailing Address - Phone:734-255-8336
Mailing Address - Fax:
Practice Address - Street 1:6633 STONY CREEK RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-6609
Practice Address - Country:US
Practice Address - Phone:734-485-8725
Practice Address - Fax:734-485-6103
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2-01418101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI201418Medicaid
MI2-01418Medicaid