Provider Demographics
NPI:1174803597
Name:HARMELING, GREGORY MICHAEL (PSYD, LMFT)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:MICHAEL
Last Name:HARMELING
Suffix:
Gender:M
Credentials:PSYD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3146 VIA POINCIANA APT 204
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-1980
Mailing Address - Country:US
Mailing Address - Phone:321-802-1343
Mailing Address - Fax:
Practice Address - Street 1:3146 VIA POINCIANA APT 204
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-1980
Practice Address - Country:US
Practice Address - Phone:321-802-1343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4947106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA#95-2633765OtherMEDI-CAL