Provider Demographics
NPI:1912772575
Name:GARDNER, TIESHA DENICE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TIESHA
Middle Name:DENICE
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 1:8637 FAWN HILL CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76134-5366
Mailing Address - Country:US
Mailing Address - Phone:281-798-4241
Mailing Address - Fax:
Practice Address - Street 1:8637 FAWN HILL CT
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76134-5366
Practice Address - Country:US
Practice Address - Phone:281-798-4241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional