Provider Demographics
NPI:1083771117
Name:GARTLAND, DIANE M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:M
Last Name:GARTLAND
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3087 PROMENADE CIR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1559
Mailing Address - Country:US
Mailing Address - Phone:734-302-0309
Mailing Address - Fax:
Practice Address - Street 1:5340 PLYMOUTH RD
Practice Address - Street 2:SUITE 209
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9341
Practice Address - Country:US
Practice Address - Phone:734-302-0309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007041103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680H113080OtherBCBSM
MI680H113080OtherBCBSM