Provider Demographics
NPI:1255603700
Name:GARDNER, GAIL DENNETTE (LPC)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:DENNETTE
Last Name:GARDNER
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 1:325 N MAIN ST
Mailing Address - Street 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:
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
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65616101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional