Provider Demographics
NPI:1871026633
Name:GARDNER, CRAIG
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:GARDNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 FLORENCE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-7904
Mailing Address - Country:US
Mailing Address - Phone:254-220-0671
Mailing Address - Fax:254-300-9938
Practice Address - Street 1:1519 FLORENCE RD STE 5
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-7904
Practice Address - Country:US
Practice Address - Phone:254-220-0671
Practice Address - Fax:254-300-9938
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-09
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73743101YP2500X
TX202536106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional