Provider Demographics
NPI:1336401314
Name:GARTMAN, AMBER N (BS,LCDC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:N
Last Name:GARTMAN
Suffix:
Gender:F
Credentials:BS,LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:COMANCHE
Mailing Address - State:TX
Mailing Address - Zip Code:76442-2708
Mailing Address - Country:US
Mailing Address - Phone:817-243-5252
Mailing Address - Fax:
Practice Address - Street 1:502 N CARVER ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3634
Practice Address - Country:US
Practice Address - Phone:432-570-3390
Practice Address - Fax:432-570-3375
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11415101YA0400X
101YM0800X, 171M00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker