Provider Demographics
NPI:1477025005
Name:GUDGEL, LORAE M (MPSY, CMA)
Entity Type:Individual
Prefix:
First Name:LORAE
Middle Name:M
Last Name:GUDGEL
Suffix:
Gender:F
Credentials:MPSY, CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W FIREWEED LN STE 105
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2044
Mailing Address - Country:US
Mailing Address - Phone:907-865-9663
Mailing Address - Fax:
Practice Address - Street 1:121 W FIREWEED LN STE 105
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2044
Practice Address - Country:US
Practice Address - Phone:907-865-9663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)