MEDICARE: ARIEL GARDNER MS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	103K00000X	Behavior Analyst
2	225400000X	Rehabilitation Practitioner
3	106H00000X	Marriage & Family Therapist	NV

General Provider Information

NPI Number	:	1902322860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIEL GARDNER MS

Provider Business Mailing Address
First Line	:	9875 ALTA MESA RD
Second Line	:
City	:	OAK HILLS
State	:	CA
Zip	:	92344-0295
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7040 LAREDO ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-3000
Country	:	US
Telephone Number	:	702-331-4874
Fax Number	:

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

Provider Enumeration Date	:	08/22/2017
Last Update Date	:	08/13/2019

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