Provider Demographics
NPI:1346908829
Name:EMBERY, GAIL LEWIS
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:LEWIS
Last Name:EMBERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 MENLO PARK DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-4910
Mailing Address - Country:US
Mailing Address - Phone:313-655-7694
Mailing Address - Fax:
Practice Address - Street 1:134 MENLO PARK DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-4910
Practice Address - Country:US
Practice Address - Phone:313-655-7694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health