Doctor Name: | JERRY GARDNER |
NPI Number: | 1467822577 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 1492 S Silicon Way #a St George, UT - 847707155 |
Business Phone Number: | 4352758911 |
Business Fax Number: | |
Mailing Address: | 150 N 3700 W Spc 122, HURRICANE |
State: | UT |
Postal Code: | 847373345 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/01/2015 |
NPI Last Update Date: | 10/01/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
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 |