Provider Demographics
NPI:1922417906
Name:GAMALSKI, LOU A (LMSW)
Entity Type:Individual
Prefix:MS
First Name:LOU
Middle Name:A
Last Name:GAMALSKI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11
Mailing Address - Street 2:
Mailing Address - City:KEWADIN
Mailing Address - State:MI
Mailing Address - Zip Code:49648-0011
Mailing Address - Country:US
Mailing Address - Phone:248-496-6530
Mailing Address - Fax:
Practice Address - Street 1:733 E 8TH ST STE 110
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-2665
Practice Address - Country:US
Practice Address - Phone:248-496-6530
Practice Address - Fax:833-268-8214
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010936361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
12770182OtherCAQH