Provider Demographics
NPI:1750879391
Name:GAMACHE, KRISTI MARGARET (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:MARGARET
Last Name:GAMACHE
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:MARGARET
Other - Last Name:DUMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA, LBA
Mailing Address - Street 1:51919 PULVER RD
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093
Mailing Address - Country:US
Mailing Address - Phone:586-623-3118
Mailing Address - Fax:
Practice Address - Street 1:51919 PULVER RD
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093
Practice Address - Country:US
Practice Address - Phone:586-623-3118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7401000707103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst