Provider Demographics
NPI:1912399908
Name:GARDENER, THAIA (LCSW CANDIDATE)
Entity Type:Individual
Prefix:MRS
First Name:THAIA
Middle Name:
Last Name:GARDENER
Suffix:
Gender:F
Credentials:LCSW CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 S HARVARD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2608
Mailing Address - Country:US
Mailing Address - Phone:918-728-2228
Mailing Address - Fax:918-728-2232
Practice Address - Street 1:4300 S HARVARD AVE STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2608
Practice Address - Country:US
Practice Address - Phone:918-728-2228
Practice Address - Fax:918-728-2232
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-27
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor