Provider Demographics
NPI:1972982841
Name:MCAVOY, GERALD (MA, LPC)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:MCAVOY
Suffix:
Gender:M
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 1:208 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1336
Mailing Address - Country:US
Mailing Address - Phone:231-547-1144
Mailing Address - Fax:
Practice Address - Street 1:208 W LINCOLN ST
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720
Practice Address - Country:US
Practice Address - Phone:231-547-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2019-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401004033101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383SYS0617-COtherHUMANA BEHAVIORAL HEALTH
MI000722974OtherOPTUM
MI1972982841OtherBCBSM PPOTRUST (55) & BCBSMMENTALHEALTH & SUBSTANCE ABUSE
MI20151209439760Medicaid
MIMIS601220445OtherMAGELLAN HEALTHCARE
MIMHPC20131030OtherMCLAREN HEALTH PLAN, MCLAREN MEDICAID, MCLAREN HMO, MCLAREN HEALTH ADVANTAGE
MICOUN18-99599OtherMICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES