Provider Demographics
NPI:1609530864
Name:GARDINER, SAMANTHA MICHELLE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:MICHELLE
Last Name:GARDINER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13025 NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-7036
Mailing Address - Country:US
Mailing Address - Phone:303-358-8265
Mailing Address - Fax:
Practice Address - Street 1:12567 W CEDAR DR STE 101
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2009
Practice Address - Country:US
Practice Address - Phone:303-691-6095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0017319101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0017319OtherLPC