Provider Demographics
NPI:1952618522
Name:GAUGER, GAYLE M (MS, LMHC,CCDVC, CCFC)
Entity type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:M
Last Name:GAUGER
Suffix:
Gender:F
Credentials:MS, LMHC,CCDVC, CCFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3176 HERON PL
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-4521
Mailing Address - Country:US
Mailing Address - Phone:727-744-2559
Mailing Address - Fax:
Practice Address - Street 1:14041 ICOT BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3702
Practice Address - Country:US
Practice Address - Phone:727-479-1839
Practice Address - Fax:727-479-1248
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7692101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004222400Medicaid
FLMH7692OtherDOH - STATE OF FLORIDA