Provider Demographics
NPI:1881874402
Name:GAMACHE, JUANITA EILEEN (LPC)
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:EILEEN
Last Name:GAMACHE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6022 ROBERTSON AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-1263
Mailing Address - Country:US
Mailing Address - Phone:615-319-7570
Mailing Address - Fax:615-354-6594
Practice Address - Street 1:6022 ROBERTSON AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-1263
Practice Address - Country:US
Practice Address - Phone:615-319-7570
Practice Address - Fax:615-354-6594
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1813101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1505416Medicaid