Provider Demographics
NPI:1922501543
Name:GANDOLFI, MEGAN MURPHY (MA, LLPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:MURPHY
Last Name:GANDOLFI
Suffix:
Gender:F
Credentials:MA, LLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3399 E GRAND RIVER AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-7555
Mailing Address - Country:US
Mailing Address - Phone:517-518-8637
Mailing Address - Fax:
Practice Address - Street 1:3399 E GRAND RIVER AVE STE 102
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-7555
Practice Address - Country:US
Practice Address - Phone:517-518-8637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016476101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1093857427Medicaid