Provider Demographics
NPI:1376751941
Name:BATHERSON, GARLAND WILLIAM (MALLP)
Entity Type:Individual
Prefix:MR
First Name:GARLAND
Middle Name:WILLIAM
Last Name:BATHERSON
Suffix:
Gender:M
Credentials:MALLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 W GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-2303
Mailing Address - Country:US
Mailing Address - Phone:810-494-7111
Mailing Address - Fax:810-494-7116
Practice Address - Street 1:822 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2303
Practice Address - Country:US
Practice Address - Phone:810-494-7111
Practice Address - Fax:810-494-7116
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006275103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily