Individual
MICHELLE C GATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2301 HOLMES ST, KANSAS CITY, MO 64108-2640
(816) 404-4375
(816) 404-4337
Mailing address
315 W CARPENTER ST, PO BOX 19677, SPRINGFIELD, IL 62702-4901
(217) 545-8000
(217) 545-0548
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2018000612
MO
103TH0004X
Health Psychologist
071-009144
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490050945
—
MO
Enumeration date
10/21/2015
Last updated
12/04/2020
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