MEDICARE: BARBARA L GARDINER MFT

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	106H00000X	Marriage & Family Therapist	MFC 30826	CA

General Provider Information

NPI Number	:	1881677342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA L GARDINER MFT

Provider Business Mailing Address
First Line	:	12842 VALLEY VIEW ST
Second Line	:	SUITE 106
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-2515
Country	:	US
Telephone Number	:	714-897-1505
Fax Number	:	714-379-5434

Provider Business Practice Location Address
First Line	:	12842 VALLEY VIEW ST
Second Line	:	SUITE 106
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-2515
Country	:	US
Telephone Number	:	714-897-1505
Fax Number	:	714-379-5434

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	07/08/2007

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