Provider Demographics
NPI:1700907979
Name:GARDNER, MARGARET ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:ANN
Last Name:GARDNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARGARET
Other - Middle Name:ANN
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3207 KERBEY LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-1450
Mailing Address - Country:US
Mailing Address - Phone:512-482-9377
Mailing Address - Fax:512-482-0327
Practice Address - Street 1:4131 SPICEWOOD SPRINGS RD
Practice Address - Street 2:C-3
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8661
Practice Address - Country:US
Practice Address - Phone:512-338-0201
Practice Address - Fax:512-482-0327
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24265103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00K71HMedicare ID - Type Unspecified