Provider Demographics
NPI:1255626727
Name:RASMUSSEN, GARY KIRK (LMSW, PSYS PHD)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:KIRK
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:LMSW, PSYS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:739 HENDRIE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3150
Mailing Address - Country:US
Mailing Address - Phone:586-872-8643
Mailing Address - Fax:248-584-3334
Practice Address - Street 1:739 HENDRIE BLVD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3150
Practice Address - Country:US
Practice Address - Phone:586-872-8643
Practice Address - Fax:248-584-3334
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010779001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical