| Doctor Name: | COLLEEN E GARDNER |
| NPI Number: | 1235343542 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC, NCC |
| License Number: | LPC-1042 |
| Business Practice Address: | 425 S. Whitley Dr., Suite #2 Fruitland, ID - 83610 |
| Business Phone Number: | 2085505063 |
| Business Fax Number: | 2085505063 |
| Mailing Address: | 425 S Whitley Dr Ste 2, FRUITLAND |
| State: | ID |
| Postal Code: | 836192681 |
| Phone Number: | 2085505063 |
| Fax Number: | 2085505063 |
| NPI Enumeration Date: | 05/09/2007 |
| NPI Last Update Date: | 12/03/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | LPC-1042 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |