Provider Demographics
NPI:1568956134
Name:GRDEN, THOMAS J (LLPC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:GRDEN
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 LUMBERJACK DR
Mailing Address - Street 2:
Mailing Address - City:DANSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48819-9653
Mailing Address - Country:US
Mailing Address - Phone:248-633-6554
Mailing Address - Fax:
Practice Address - Street 1:2650 LUMBERJACK DR
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48819-9653
Practice Address - Country:US
Practice Address - Phone:248-633-6554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016433101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor