Provider Demographics
NPI:1124218581
Name:GARDNER, KIMBERLY CLAIRE (LCSW, LAC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CLAIRE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3132
Mailing Address - Country:US
Mailing Address - Phone:406-442-6613
Mailing Address - Fax:406-442-7949
Practice Address - Street 1:500 S LAMBORN ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5417
Practice Address - Country:US
Practice Address - Phone:406-465-7568
Practice Address - Fax:406-442-7949
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT527101YA0400X
MT5041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT504OtherSTATE OF MONTANA LICENSE
MT527OtherSTATE OF MONTANA LICENSE