MEDICARE: GARDNER HOUSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	5737	TX
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	5737	TX
3	101YM0800X	Mental Health Counselor	06143, 5737	TX
4	104100000X	Social Worker	06143	TX

General Provider Information

NPI Number	:	1144691239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDNER HOUSE

Provider Business Mailing Address
First Line	:	11717 BEAMER RD
Second Line	:	#245
City	:	HOUSTON
State	:	TX
Zip	:	77089
Country	:	US
Telephone Number	:	281-481-1774
Fax Number	:	281-464-8683

Provider Business Practice Location Address
First Line	:	9000 FREY RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77034-3506
Country	:	US
Telephone Number	:	281-481-1774
Fax Number	:	281-464-8683

Authorized Official
Title or Position	:	PROPRIETOR
Name	:	BEVERLY GARDNER-NELSON
Credential	:	LMSW-AP, LCDC
Telephone Number	:	281-481-1774

Provider Enumeration Date	:	10/14/2015
Last Update Date	:	10/14/2015

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Directions to “GARDNER HOUSE ” Practice Location

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