Provider Demographics
NPI:1033658281
Name:GARDNER, SHANNA C (LPC)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:C
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 S LOOP W
Mailing Address - Street 2:SUITE 475
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1301
Mailing Address - Country:US
Mailing Address - Phone:713-383-0888
Mailing Address - Fax:713-383-0895
Practice Address - Street 1:3003 S LOOP W
Practice Address - Street 2:SUITE 475
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1301
Practice Address - Country:US
Practice Address - Phone:713-383-0888
Practice Address - Fax:713-383-0895
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73365101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX73365OtherLICENSE