Provider Demographics
NPI:1164967766
Name:GARDNER, ANNETTE HARSTON (CMHC)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:HARSTON
Last Name:GARDNER
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2639 S 4010 W
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-7766
Mailing Address - Country:US
Mailing Address - Phone:435-680-2681
Mailing Address - Fax:
Practice Address - Street 1:169 W 2710 SOUTH CIR STE 203F
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7251
Practice Address - Country:US
Practice Address - Phone:435-817-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10122356-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health