Healthcare Provider Details

I. General information

NPI: 1952666232
Provider Name (Legal Business Name): AARON F GARDNER MA, LPC, CMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MR. FAY AARON GARDNER

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 S 1200 W
PERRY UT
84302-4226
US

IV. Provider business mailing address

2800 S 1200 W
PERRY UT
84302-4226
US

V. Phone/Fax

Practice location:
  • Phone: 435-723-2881
  • Fax: 435-734-2719
Mailing address:
  • Phone: 801-686-9334
  • Fax: 801-326-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number296354-6004
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: