Doctor Name: | MR. MELVIN LEE GARDNER |
NPI Number: | 1003139874 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.A., L.P.C. |
License Number: | L1543766 |
Business Practice Address: | 3256 University Dr Suite 30 Auburn Hills, MI - 483262393 |
Business Phone Number: | 2484750688 |
Business Fax Number: | |
Mailing Address: | 3256 University Dr, Suite 30 AUBURN HILLS |
State: | MI |
Postal Code: | 483262393 |
Phone Number: | 2484750688 |
Fax Number: | |
NPI Enumeration Date: | 03/09/2010 |
NPI Last Update Date: | 03/09/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | L1543766 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |