Provider Demographics
NPI:1710306824
Name:GAMRAT, DENISE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:GAMRAT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 LAPEER ROAD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362
Mailing Address - Country:US
Mailing Address - Phone:248-693-7526
Mailing Address - Fax:
Practice Address - Street 1:715 N LAPEER RD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-1530
Practice Address - Country:US
Practice Address - Phone:248-693-7526
Practice Address - Fax:248-693-2426
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007946101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional