Provider Demographics
NPI:1841279452
Name:GARDNER, CAROL IRENE (LPC)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:IRENE
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 1:1711 S POLK ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79102-3152
Mailing Address - Country:US
Mailing Address - Phone:806-354-0727
Mailing Address - Fax:806-354-0011
Practice Address - Street 1:1711 S POLK ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79102-3152
Practice Address - Country:US
Practice Address - Phone:806-354-0727
Practice Address - Fax:806-354-0011
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13496101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0956039-03OtherTPMHMR MEDICAID LEGACY
TX0956039-02Medicaid
TX3230LCOtherBLUE CROSS/BLUE SHIELD