Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | L1543766 | MI |
NPI | 1003139874 |
---|---|
Provider Name | Mr. Melvin Lee Gardner |
First Address | Auburn Hills, MI 48326-2393 |
Second Address | Auburn Hills, MI 48326-2393 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2010 |
Last Update Date | 09/03/2010 |