Individual
MR. KENNETH GARY GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMHC
Contact information
Practice address
1810 DOGWOOD DR, KOKOMO, IN 46902-5737
(765) 553-5693
(765) 553-5772
Mailing address
2106 EASTBROOK DR, KOKOMO, IN 46902-4513
(765) 455-4067
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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