Provider Demographics
NPI:1275074023
Name:GHERARDI, MARK JOSEPH (MA LPC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:JOSEPH
Last Name:GHERARDI
Suffix:
Gender:M
Credentials:MA LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4103 S TEXAS AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-4043
Mailing Address - Country:US
Mailing Address - Phone:979-361-7907
Mailing Address - Fax:979-846-6557
Practice Address - Street 1:4103 S TEXAS AVE STE 203
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-4043
Practice Address - Country:US
Practice Address - Phone:979-361-7907
Practice Address - Fax:979-846-6557
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69780101YP2500X
TX201939106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional