Individual
COLLEEN E GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC, NCC
Contact information
Practice address
425 S. WHITLEY DR., SUITE #2, FRUITLAND, ID 83610
(208) 550-5063
(208) 550-5063
Mailing address
425 S WHITLEY DR STE 2, FRUITLAND, ID 83619-2681
(208) 550-5063
(208) 550-5063
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LPC-1042
WY
101YP2500X
Professional Counselor
Primary
LCPC 5007
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108969200
—
WY
05
—
108969201
—
WY
05
—
108969202
—
WY
05
—
108969203
—
WY
Enumeration date
05/09/2007
Last updated
12/03/2013
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