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General NPI Number Information
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NPI Number | 1710972922
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Entity Type | Individual
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Provider Name | CARRIE GARDNER MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 09/14/2005
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Last Update Date | 02/06/2019
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Provider Practice Location Address
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Address Line | 807 8TH ST STE 1212
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City | WICHITA FALLS
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State | TX
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Zip | 76301
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Country | US
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Telephone | 940-264-1212
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Fax | 940-264-1213
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Provider Business Mailing Address
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Address Line | 807 8TH ST STE 1212
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City | WICHITA FALLS
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State | TX
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Zip | 76301-3319
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Country | US
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Telephone | 940-264-1212
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Fax | 940-264-1213
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC14599
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License Number State | TX
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