Individual
MICHAEL J GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
805 N ORANGE ST, BUTLER, MO 64730
(888) 403-1071
Mailing address
1800 COMMUNITY, CLINTON, MO 64735-8804
(660) 885-8131
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
01101
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
493346001
—
MO
Enumeration date
12/22/2005
Last updated
05/25/2018
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