| Doctor Name: | BEVERLY GARDNER |
| NPI Number: | 1003904152 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 1820 |
| Business Practice Address: | 10 Boulder Crescent St Suite 203f Colorado Springs, CO - 809033344 |
| Business Phone Number: | 7196605281 |
| Business Fax Number: | 8667031432 |
| Mailing Address: | 10 Boulder Crescent St, Suite 203f COLORADO SPRINGS |
| State: | CO |
| Postal Code: | 809033344 |
| Phone Number: | 7196605281 |
| Fax Number: | |
| NPI Enumeration Date: | 10/11/2006 |
| NPI Last Update Date: | 03/03/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 1820 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |