Basic Information
| Provider Information | |||||||||
| NPI: | 1326776451 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOUCHEY | ||||||||
| FirstName: | GERALD | ||||||||
| MiddleName: | STANLEY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1317 LAUREL VIEW DR | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481059411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342558336 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6633 STONY CREEK RD | ||||||||
| Address2: | |||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481976609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344858725 | ||||||||
| FaxNumber: | 7344856103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2022 | ||||||||
| LastUpdateDate: | 08/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 2-01418 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 201418 | 05 | MI | MEDICAID | 2-01418 | 05 | MI | MEDICAID |