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General NPI Number Information
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NPI Number | 1275074023
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Entity Type | Individual
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Provider Name | MARK JOSEPH GHERARDI M.A. LPC, LMFT
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Gender | Male
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 4103 S TEXAS AVE STE 203
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City | BRYAN
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State | TX
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Zip | 77802-4043
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Country | US
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Telephone | 979-361-7907
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Fax | 979-846-6557
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Provider Business Mailing Address
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Address Line | 4103 S TEXAS AVE STE 203
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City | BRYAN
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State | TX
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Zip | 77802-4043
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Country | US
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Telephone | 979-361-7907
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Fax | 979-846-6557
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 69780
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 201939
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License Number State | TX
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