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General NPI Number Information
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NPI Number | 1164810859
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Entity Type | Individual
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Provider Name | LAURA MICHELE GARDNER MA, MFT
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Gender | Female
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Dates
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Enumeration Date | 01/02/2015
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 3300 POWELL ST STE 207
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City | EMERYVILLE
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State | CA
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Zip | 94608-1515
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Country | US
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Telephone | 510-594-4300
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Fax | 510-768-5577
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Provider Business Mailing Address
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Address Line | PO BOX 19099
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City | OAKLAND
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State | CA
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Zip | 94619-0099
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Country | US
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Telephone | 510-594-4300
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Fax | 510-768-5577
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | T1862
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 53622
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License Number State | CA
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