Provider Demographics
NPI:1104597921
Name:GARNER, MALINDA (LPC)
Entity type:Individual
Prefix:
First Name:MALINDA
Middle Name:
Last Name:GARNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:MALINDA
Other - Middle Name:CAY
Other - Last Name:GARNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:5533 TUXBURY POND DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-1498
Mailing Address - Country:US
Mailing Address - Phone:817-304-0261
Mailing Address - Fax:
Practice Address - Street 1:5533 TUXBURY POND DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-1498
Practice Address - Country:US
Practice Address - Phone:817-304-0261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81134101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional