Provider Demographics
NPI:1598840571
Name:PREPSKY, GORDON R (MA, LLP)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:R
Last Name:PREPSKY
Suffix:
Gender:M
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3124 WILLIAMSBURG RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2074
Mailing Address - Country:US
Mailing Address - Phone:734-645-8559
Mailing Address - Fax:
Practice Address - Street 1:2890 CARPENTER RD
Practice Address - Street 2:SUITE 1600
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1100
Practice Address - Country:US
Practice Address - Phone:734-677-0609
Practice Address - Fax:734-677-3072
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006671103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist