Basic Information
| Provider Information | |||||||||
| NPI: | 1154424455 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZEMENS | ||||||||
| FirstName: | GERALD | ||||||||
| MiddleName: | CHARLES | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S MAIN ST | ||||||||
| Address2: | PO BOX 678 | ||||||||
| City: | ALMONT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480031073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8104415396 | ||||||||
| FaxNumber: | 8107983561 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 STODDARD ROAD | ||||||||
| Address2: | BOX 41038 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103922167 | ||||||||
| FaxNumber: | 8103923530 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 500044 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.