Provider Demographics
NPI:1598282188
Name:GARDNER-YOUNG, ANDREA R (ACMHC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:R
Last Name:GARDNER-YOUNG
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2493 W DUTCH DRAW DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-4909
Mailing Address - Country:US
Mailing Address - Phone:801-259-1350
Mailing Address - Fax:
Practice Address - Street 1:5689 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5447
Practice Address - Country:US
Practice Address - Phone:801-259-1350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7403966-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health