Provider Demographics
NPI:1801998406
Name:GATELY, MICHAEL J
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:GATELY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 CURIE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2909
Mailing Address - Country:US
Mailing Address - Phone:915-542-4951
Mailing Address - Fax:905-542-0883
Practice Address - Street 1:1733 CURIE
Practice Address - Street 2:SUITE 204
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2909
Practice Address - Country:US
Practice Address - Phone:915-542-4951
Practice Address - Fax:905-542-0883
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLISWI2354104100000X
TXLCSWS141201041C0700X
TXLMFT50144348106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S94LMedicare ID - Type Unspecified