Provider Demographics
NPI:1477881431
Name:GARDNER-MORON, FAITH (LMSW)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:GARDNER-MORON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSS,MLSP
Mailing Address - Street 1:2501 LAZY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8627
Mailing Address - Country:US
Mailing Address - Phone:956-792-4843
Mailing Address - Fax:956-423-0439
Practice Address - Street 1:1616 S CAROLINA ST
Practice Address - Street 2:SUITE A
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8316
Practice Address - Country:US
Practice Address - Phone:956-792-4843
Practice Address - Fax:956-423-0439
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16430101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional