Provider Demographics
NPI:1104941848
Name:GARDNER, BARBARA CHISOLM (MFT)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:CHISOLM
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 E LOOP DR
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1333
Mailing Address - Country:US
Mailing Address - Phone:805-388-5242
Mailing Address - Fax:
Practice Address - Street 1:4000 S ROSE AVE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-6699
Practice Address - Country:US
Practice Address - Phone:805-986-7374
Practice Address - Fax:805-986-7305
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 33001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist