MEDICARE: DR. CAROL IRENE GARDNER LPC

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	101YP2500X	Professional Counselor	13496	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3230LC	OTHER	TX	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1841279452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL IRENE GARDNER LPC

Provider Business Mailing Address
First Line	:	1711 S POLK ST
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79102-3152
Country	:	US
Telephone Number	:	806-354-0727
Fax Number	:	806-354-0011

Provider Business Practice Location Address
First Line	:	1711 S POLK ST
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79102-3152
Country	:	US
Telephone Number	:	806-354-0727
Fax Number	:	806-354-0011

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	09/06/2007

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