Provider Demographics
NPI:1629167192
Name:MAJOR, GARY (PHD)
Entity Type:Individual
Prefix:PROF
First Name:GARY
Middle Name:
Last Name:MAJOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:MAJOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10229 W GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-3911
Mailing Address - Country:US
Mailing Address - Phone:414-453-6330
Mailing Address - Fax:414-453-6523
Practice Address - Street 1:10229 W GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-3911
Practice Address - Country:US
Practice Address - Phone:414-453-6330
Practice Address - Fax:414-453-6523
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1274-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39078200Medicaid