Provider Demographics
NPI:1851538995
Name:GARDNER, ANDREW WAINE (PHD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:WAINE
Last Name:GARDNER
Suffix:
Gender:M
Credentials:PHD, BCBA-D
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Other - First Name:
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Mailing Address - Street 1:535 N WILMOT RD STE 201
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2629
Mailing Address - Country:US
Mailing Address - Phone:520-694-1234
Mailing Address - Fax:
Practice Address - Street 1:906 W UNIVERSITY AVE - SUITE #120
Practice Address - Street 2:BEHAVIORAL CONSULTATION SERVICES OF NORTHERN ARIZONA
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-2986
Practice Address - Country:US
Practice Address - Phone:928-522-3780
Practice Address - Fax:928-563-0048
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1-08-4345103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst