Provider Demographics
NPI:1376251538
Name:GATY, LOUIS JOSEPH IV
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:JOSEPH
Last Name:GATY
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9352 MELBOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1452
Mailing Address - Country:US
Mailing Address - Phone:313-287-6299
Mailing Address - Fax:
Practice Address - Street 1:9352 MELBOURNE AVE
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1452
Practice Address - Country:US
Practice Address - Phone:313-287-6299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst