Doctor Name: | JOSEPH GARDNER |
NPI Number: | 1831528579 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | TH.M LPC |
License Number: | 6401004759 |
Business Practice Address: | 1049 E Newell St White Cloud, MI - 493498795 |
Business Phone Number: | 2316897330 |
Business Fax Number: | |
Mailing Address: | 1049 E Newell St, WHITE CLOUD |
State: | MI |
Postal Code: | 493498795 |
Phone Number: | 2316897330 |
Fax Number: | |
NPI Enumeration Date: | 11/04/2013 |
NPI Last Update Date: | 11/04/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 6401004759 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |