Healthcare Provider Details

I. General information

NPI: 1336818772
Provider Name (Legal Business Name): MYA LYNN GARTENSLEBEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 MAIN ST STE 300
COLUMBIA SC
29201-3266
US

IV. Provider business mailing address

340 PIN OAK DR
LEXINGTON SC
29073-7915
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-25-15896
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: