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General NPI Number Information
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NPI Number | 1033483276
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Entity Type | Organization
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Legal Business Name | BEVERLY GARDNER LLC
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 10 BOULDER CRESCENT ST SUITE 203F
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-3344
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Country | US
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Telephone | 719-660-5281
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Fax | 866-703-1432
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Provider Business Mailing Address
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Address Line | 10 BOULDER CRESCENT ST SUITE 203F
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-3344
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Country | US
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Telephone | 719-660-5281
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Fax | 866-703-1432
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Authorized Official
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Title or Position | COUNSELOR
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Name | BEVERLY GARDNER
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Credential | LPC
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Telephone | 719-660-5281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1820
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License Number State | CO
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