Provider Demographics
NPI:1093865065
Name:GARDNER-NELSON, BEVERLY ANN (LMSW-AP, LCDC, CCJP)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:ANN
Last Name:GARDNER-NELSON
Suffix:
Gender:F
Credentials:LMSW-AP, LCDC, CCJP
Other - Prefix:MS
Other - First Name:BEVERLY
Other - Middle Name:ANN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW-AP, LCDC, CCJP
Mailing Address - Street 1:11717 BEAMER RD
Mailing Address - Street 2:APT. 245
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-3100
Mailing Address - Country:US
Mailing Address - Phone:281-481-1774
Mailing Address - Fax:281-464-8683
Practice Address - Street 1:9000 FREY RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-3506
Practice Address - Country:US
Practice Address - Phone:713-851-5302
Practice Address - Fax:281-464-8683
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS06143101Y00000X, 104100000X
TX5737101YA0400X
TX06143251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker