Provider Information for 1962951004
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Mr. SEAN GARDNER LPC, MS, LMHC
Sex: Male
NPI: 1962951004
Last Updated: 2023-12-01
Certification Date: 2023-12-01
Certification Date: 2023-12-01
Details
| Name | Value | ||||||||||||||||
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| NPI | 1962951004 | ||||||||||||||||
| Enumeration Date | 2016-09-30 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 3101 N CENTRAL AVE STE 550 PHOENIX, AZ 85012-2635 United States Phone: 602-230-7373 | Fax:602-682-7455 | ||||||||||||||||
| Primary Practice Address | 235 W WESTERN AVE AVONDALE, AZ 85323-1848 United States Phone: 602-230-7373 | Fax:602-230-3086 | ||||||||||||||||
| Secondary Practice Address(es) | 4455 NE HIGHWAY 20 970 N KALAHEO AVE STE C201 | ||||||||||||||||
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