Provider Information for 1497316848
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SHEILA MARIE GAULT LPC
Sex: Female
NPI: 1497316848
Last Updated: 2023-08-28
Certification Date: 2023-08-28
Certification Date: 2023-08-28
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1497316848 | ||||||||||||
| Enumeration Date | 2019-06-26 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 888 W BIG BEAVER RD TROY, MI 48084-4736 United States Phone: 248-244-8644 | Fax:248-244-1330 | ||||||||||||
| Primary Practice Address | 127 N RIVER ST FENTON, MI 48430-3800 United States Phone: 810-309-9355 | Fax:810-750-1152 | ||||||||||||
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