Provider Demographics
NPI:1861828378
Name:STROH, GAYLE M (MA)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:M
Last Name:STROH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 ASSOCIATION DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-4902
Mailing Address - Country:US
Mailing Address - Phone:517-349-9488
Mailing Address - Fax:
Practice Address - Street 1:2211 ASSOCIATION DR
Practice Address - Street 2:SUITE 500
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-4902
Practice Address - Country:US
Practice Address - Phone:517-349-9488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006242103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist