Individual
DR. THEODORE GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
401 GOODING ST N, STE 105, TWIN FALLS, ID 83301-6177
(208) 320-7525
(208) 904-0644
Mailing address
PO BOX 231396, MONTGOMERY, AL 36123-1396
(334) 213-8803
(334) 213-8815
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY-202709
ID
Other
Enumeration date
08/29/2012
Last updated
08/17/2017
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