Individual
ERIC J. GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY. D.
Contact information
Practice address
516 EAST NIZHONI BLVD., GALLUP, NM 87301-1337
(505) 722-1000
(505) 722-1396
Mailing address
P.O. BOX 1337, GALLUP, NM 87305-1337
(505) 722-1000
(505) 722-1396
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PSY24300
CA
103TC0700X
Clinical Psychologist
Primary
24300
CA
390200000X
Student in an Organized Health Care Education/Training Program
PSB33057
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PSB33057
PSYCH. ASSISTANT NUMBER
CA
Enumeration date
09/19/2007
Last updated
08/09/2019
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