Provider Demographics
NPI:1972870681
Name:GARDNER EDDINS, AMBER DEON (MA, LPC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:DEON
Last Name:GARDNER EDDINS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S.W. 26TH, ST 200
Mailing Address - Street 2:CEDAR FORUM
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109
Mailing Address - Country:US
Mailing Address - Phone:806-674-2004
Mailing Address - Fax:
Practice Address - Street 1:S.W. 26TH, ST 200
Practice Address - Street 2:CEDAR FORUM
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109
Practice Address - Country:US
Practice Address - Phone:806-674-2004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65580101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional