Provider Demographics
NPI:1962527044
Name:GARDNER, SHELLEY (LCMHC)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MARY E CLARK DR
Mailing Address - Street 2:UNIT 8
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03841-2292
Mailing Address - Country:US
Mailing Address - Phone:603-964-4869
Mailing Address - Fax:603-964-4980
Practice Address - Street 1:20 MARY E CLARK DR
Practice Address - Street 2:UNIT 8
Practice Address - City:HAMPSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03841-2292
Practice Address - Country:US
Practice Address - Phone:603-964-4869
Practice Address - Fax:603-964-4980
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH93101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health