Individual
MRS. GAYLE BEVILL-DADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3514 STELLHORN RD, FORT WAYNE, IN 46815-4631
(260) 492-5500
(260) 422-1555
Mailing address
125 LEXINGTON AVE, FORT WAYNE, IN 46807-2429
(260) 456-4801
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39001423A
IN
Other
Enumeration date
09/15/2006
Last updated
07/08/2007
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