Provider Demographics
NPI:1124141957
Name:GAY, RICHARD L (PHD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:GAY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 SPRUCE HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49333-8939
Mailing Address - Country:US
Mailing Address - Phone:616-260-3558
Mailing Address - Fax:
Practice Address - Street 1:859 SPRUCE HOLLOW DR
Practice Address - Street 2:
Practice Address - City:MIDDLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:49333-8939
Practice Address - Country:US
Practice Address - Phone:616-260-3558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2019-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301000737103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM78630Medicare ID - Type Unspecified