Provider Demographics
NPI:1639802424
Name:GATTIS, MELVIN FRANKLIN II (LPC)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:FRANKLIN
Last Name:GATTIS
Suffix:II
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CENTRAL AVE APT 425
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-5479
Mailing Address - Country:US
Mailing Address - Phone:973-494-3164
Mailing Address - Fax:
Practice Address - Street 1:67 SANFORD ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1926
Practice Address - Country:US
Practice Address - Phone:973-673-3342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00436300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional