Individual
DR. CAROL IRENE GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1711 S POLK ST, AMARILLO, TX 79102-3152
(806) 354-0727
(806) 354-0011
Mailing address
1711 S POLK ST, AMARILLO, TX 79102-3152
(806) 354-0727
(806) 354-0011
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
13496
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0956039-02
—
TX
01
—
0956039-03
TPMHMR MEDICAID LEGACY
TX
01
—
3230LC
BLUE CROSS/BLUE SHIELD
TX
Enumeration date
01/11/2006
Last updated
09/06/2007
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