Provider Demographics
NPI:1629588207
Name:RUBLE, GAYLE JR
Entity Type:Individual
Prefix:MR
First Name:GAYLE
Middle Name:
Last Name:RUBLE
Suffix:JR
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 1:136 E MAUMEE ST STE 8
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-2724
Mailing Address - Country:US
Mailing Address - Phone:517-438-8144
Mailing Address - Fax:517-438-8195
Practice Address - Street 1:136 E MAUMEE ST STE 8
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2724
Practice Address - Country:US
Practice Address - Phone:517-438-8144
Practice Address - Fax:517-438-8195
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016174101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor