Provider Demographics
NPI:1780885582
Name:GARDNER, LEANNE LYNNE (MA, LMFT)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:LYNNE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 BRECKENRIDGE LN
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-2192
Mailing Address - Country:US
Mailing Address - Phone:502-493-0052
Mailing Address - Fax:502-493-0052
Practice Address - Street 1:3044 BRECKENRIDGE LN
Practice Address - Street 2:SUITE 204
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-2192
Practice Address - Country:US
Practice Address - Phone:502-493-0052
Practice Address - Fax:502-493-0052
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0323106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist