Provider Demographics
NPI:1982323713
Name:GARDINER, JESSE THOMAS (BA, MS, CPC INTERN)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:THOMAS
Last Name:GARDINER
Suffix:
Gender:M
Credentials:BA, MS, CPC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2743
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-2743
Mailing Address - Country:US
Mailing Address - Phone:702-768-1443
Mailing Address - Fax:
Practice Address - Street 1:975 ROBERTA LN
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-6812
Practice Address - Country:US
Practice Address - Phone:775-525-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI5170101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health