Healthcare Provider Details

I. General information

NPI: 1548392129
Provider Name (Legal Business Name): JAMES PRESTON GARDEPE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 WILLOWBROOK DR SE SUITE C
HUNTSVILLE AL
35802-3262
US

IV. Provider business mailing address

915 WILLOWBROOK DR SE SUITE C
HUNTSVILLE AL
35802-3262
US

V. Phone/Fax

Practice location:
  • Phone: 256-882-2004
  • Fax:
Mailing address:
  • Phone: 256-882-2004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number523
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number523
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number523
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: