Provider Demographics
NPI:1548392129
Name:GARDEPE, JAMES PRESTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PRESTON
Last Name:GARDEPE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 WILLOWBROOK DR SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-3262
Mailing Address - Country:US
Mailing Address - Phone:256-882-2004
Mailing Address - Fax:
Practice Address - Street 1:915 WILLOWBROOK DR SE
Practice Address - Street 2:SUITE C
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-3262
Practice Address - Country:US
Practice Address - Phone:256-882-2004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL523103T00000X, 103TB0200X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000074448Medicaid
AL510-74448GAROtherBCBS OF ALABAMA
AL529400650Medicaid