Provider Demographics
NPI:1588647077
Name:GARDNER, AARON PAUL (MA, LMHC, ICAC-II)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:PAUL
Last Name:GARDNER
Suffix:
Gender:M
Credentials:MA, LMHC, ICAC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9111 HAVERSTICK RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1353
Mailing Address - Country:US
Mailing Address - Phone:317-575-6500
Mailing Address - Fax:
Practice Address - Street 1:9111 HAVERSTICK RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1353
Practice Address - Country:US
Practice Address - Phone:317-575-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN00333101YA0400X
IN39001707101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)