Provider Demographics
NPI:1942575212
Name:GARDNER COUNSELING & WELLNESS PLLC
Entity Type:Organization
Organization Name:GARDNER COUNSELING & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:DENNETTE
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:254-933-2273
Mailing Address - Street 1:325 N MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-3162
Mailing Address - Country:US
Mailing Address - Phone:254-933-2273
Mailing Address - Fax:254-933-2531
Practice Address - Street 1:325 N MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-3162
Practice Address - Country:US
Practice Address - Phone:254-933-2273
Practice Address - Fax:254-933-2531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65616101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty