Provider Demographics
NPI:1508563206
Name:GARDNER, HOLLY (LMHC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20450 COLONIAL HILL DR UNIT 208
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3691
Mailing Address - Country:US
Mailing Address - Phone:617-960-6777
Mailing Address - Fax:
Practice Address - Street 1:1787 S PINELLAS AVE STE 400
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-1929
Practice Address - Country:US
Practice Address - Phone:727-422-0996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21872101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty