Provider Demographics
NPI:1437480985
Name:GAVETTI, MICHAEL F (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:F
Last Name:GAVETTI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5909 SHELBY OAKS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-7317
Mailing Address - Country:US
Mailing Address - Phone:901-383-9193
Mailing Address - Fax:901-383-9195
Practice Address - Street 1:5909 SHELBY OAKS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-7317
Practice Address - Country:US
Practice Address - Phone:901-383-9193
Practice Address - Fax:901-383-9195
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2678103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling