Provider Demographics
NPI:1588673701
Name:GARD, GARY CARL (PHD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:CARL
Last Name:GARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10040 REGENCY CIR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3723
Mailing Address - Country:US
Mailing Address - Phone:402-393-5432
Mailing Address - Fax:402-393-0220
Practice Address - Street 1:10040 REGENCY CIR
Practice Address - Street 2:SUITE 250
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3723
Practice Address - Country:US
Practice Address - Phone:402-393-5432
Practice Address - Fax:402-393-0220
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE181103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE421426801000Medicaid
NE103230OtherMANAGED HEALTH NETWORK
NE048369OtherVALUEOPTIONS
NE08430OtherBLUE CROSS / BLUE SHIELD
NE4786OtherMIDLANDS CHOICE
NE08430OtherBLUE CROSS / BLUE SHIELD
NE4786OtherMIDLANDS CHOICE