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Individual
MR. KENNETH GARY GARDNER
Active
Individual
MR. KENNETH GARY GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMHC
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39000566A
IN
171100000X
Acupuncturist
80000010A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000343499
ANTHEM BX/BS ID NUMBER
IN
01
—
083845-000
MAGELLAN ID NUMBER
IN
01
—
11347555
CAQH ID NUMBER
IN
01
—
2067371
CIGNA ID NUMBER
IN
01
—
GARDN-0005
COMPCARE ID NUMBER
IN
Enumeration date
08/01/2006
Last updated
09/07/2022
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