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General NPI Number Information
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NPI Number | 1396035986
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Entity Type | Individual
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Provider Name | MARY JO GARDNER DENMAN LLPC
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Gender | Female
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Dates
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Enumeration Date | 04/15/2011
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Last Update Date | 05/04/2012
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Provider Practice Location Address
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Address Line | 13101 ALLEN RD
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City | SOUTHGATE
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State | MI
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Zip | 48195-2216
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Country | US
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Telephone | 734-785-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 13660 PEACH ST
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City | SOUTHGATE
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State | MI
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Zip | 48195-1320
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Country | US
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Telephone | 734-285-7098
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Fax |
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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 | L2079431
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | PV0000000772837
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License Number State | MI
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