Provider Demographics
NPI:1447517891
Name:GAMEL, KIERNAN (CAC-R, CCS-M)
Entity type:Individual
Prefix:
First Name:KIERNAN
Middle Name:
Last Name:GAMEL
Suffix:
Gender:M
Credentials:CAC-R, CCS-M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 JOY AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-1933
Mailing Address - Country:US
Mailing Address - Phone:517-782-2551
Mailing Address - Fax:517-783-1986
Practice Address - Street 1:1522 JOY AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-1933
Practice Address - Country:US
Practice Address - Phone:517-782-2551
Practice Address - Fax:517-783-1986
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)