Individual
DR. DIANE MARILEE GARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
122 S GUN BARREL LN, SUITE 6, GUN BARREL CITY, TX 75156-9403
(903) 887-0697
(903) 887-0698
Mailing address
PO BOX 2107, MABANK, TX 75147-5017
(903) 368-2299
(903) 489-0111
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
2264
CO
103TC0700X
Clinical Psychologist
Primary
33829
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
614301
MEDICARE B
TX
Enumeration date
11/21/2006
Last updated
02/22/2012
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