Provider Demographics
NPI:1689896037
Name:GEMAEHLICH, SAMUAL L (RTEI)
Entity Type:Individual
Prefix:MR
First Name:SAMUAL
Middle Name:L
Last Name:GEMAEHLICH
Suffix:
Gender:M
Credentials:RTEI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5712 SCOTT RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FORT JONES
Mailing Address - State:CA
Mailing Address - Zip Code:96032
Mailing Address - Country:US
Mailing Address - Phone:530-468-2469
Mailing Address - Fax:
Practice Address - Street 1:1515 S OREGON STREET
Practice Address - Street 2:SUITE A
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097
Practice Address - Country:US
Practice Address - Phone:530-842-3455
Practice Address - Fax:530-842-7917
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker