Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 1820 | CO |
NPI | 1003904152 |
---|---|
Provider Name | Beverly Gardner |
First Address | Colorado Springs, CO 80903-3344 |
Second Address | Colorado Springs, CO 80903-3344 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 03/03/2012 |