Provider Demographics
NPI:1982876975
Name:GARDNER, CAROLYN (LPC)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
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 1:3925 I-35 SOUTH
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76706-3775
Mailing Address - Country:US
Mailing Address - Phone:254-714-0189
Mailing Address - Fax:
Practice Address - Street 1:3925 I-35 SOUTH
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76706-3775
Practice Address - Country:US
Practice Address - Phone:254-714-0189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19995101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health