Provider Demographics
NPI:1265126999
Name:GARDNER, JUSTIN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:GARDNER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 S VAL VISTA DR STE 146
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1636
Mailing Address - Country:US
Mailing Address - Phone:480-454-7680
Mailing Address - Fax:
Practice Address - Street 1:2680 S VAL VISTA DR STE 146
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1636
Practice Address - Country:US
Practice Address - Phone:480-454-7680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005831103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist