Provider Demographics
NPI:1306402854
Name:GARDEN, MARK (LMHC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:GARDEN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 S 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-2022
Mailing Address - Country:US
Mailing Address - Phone:563-940-2321
Mailing Address - Fax:
Practice Address - Street 1:2435 KIMBERLY RD STE 96S
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3505
Practice Address - Country:US
Practice Address - Phone:563-940-2321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079924101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health