Provider Demographics
NPI:1346497708
Name:MCCORMICK, GAYLE L (MED)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:L
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 478
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362
Mailing Address - Country:US
Mailing Address - Phone:360-374-5011
Mailing Address - Fax:360-374-6691
Practice Address - Street 1:3430 HWY 101 E,
Practice Address - Street 2:SUITE 10
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362
Practice Address - Country:US
Practice Address - Phone:360-452-4062
Practice Address - Fax:360-452-4189
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00004779101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health