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General NPI Number Information
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NPI Number | 1144691239
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Entity Type | Organization
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Legal Business Name | GARDNER HOUSE
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Dates
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Enumeration Date | 10/14/2015
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Last Update Date | 10/14/2015
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Provider Practice Location Address
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Address Line | 9000 FREY RD
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City | HOUSTON
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State | TX
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Zip | 77034-3506
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Country | US
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Telephone | 281-481-1774
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Fax | 281-464-8683
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Provider Business Mailing Address
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Address Line | 11717 BEAMER RD #245
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City | HOUSTON
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State | TX
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Zip | 77089
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Country | US
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Telephone | 281-481-1774
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Fax | 281-464-8683
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Authorized Official
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Title or Position | PROPRIETOR
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Name | BEVERLY GARDNER-NELSON
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Credential | LMSW-AP, LCDC
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Telephone | 281-481-1774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 5737
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 5737
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 06143, 5737
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 06143
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License Number State | TX
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