Provider Demographics
NPI:1659510600
Name:GAYLE SEELY LLC
Entity Type:Organization
Organization Name:GAYLE SEELY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEELY
Authorized Official - Suffix:
Authorized Official - Credentials:LLC
Authorized Official - Phone:517-437-0309
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-0187
Mailing Address - Country:US
Mailing Address - Phone:517-523-3695
Mailing Address - Fax:517-523-3311
Practice Address - Street 1:101 E BACON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-1666
Practice Address - Country:US
Practice Address - Phone:517-437-0309
Practice Address - Fax:517-437-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007751101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
367044359OtherTRICARE