Theodore Gardner, PH.D.
Individual provider Active NPI Clinical Psychologist · Twin Falls, ID
NPI 1851649461 · NPPES record last updated Aug 17, 2017
Key facts
- NPI
- 1851649461
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PSY-202709 (ID)
- Practice address
- 401 Gooding St N
Ste 105
Twin Falls, ID 83301-6177 - Phone
- (208) 320-7525
- Fax
- (208) 904-0644
- NPI assigned
- Aug 29, 2012
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY-202709 | ID | MD | Clinical Psychologist |
| 2059 | AL | MD | Registered Dietitian |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY-202709 | ID | Yes |
Addresses
Primary practice location
401 Gooding St N
Ste 105
Twin Falls, ID 83301-6177
Mailing address
PO Box 231396
Montgomery, AL 36123-1396
Phone (334) 213-8803
Other providers in Twin Falls, ID
- Christopher Aaron Ganz
- Deborah A Garbett
- Michael Garbett
- Eva Marie Garcia
- Jennifer Anne Gardner
- Paul Richard Garn
- Stephanie Garrison
- Gary P Walker OD PC
- Jessica Gaston
- Geddes LLC
All providers in Twin Falls, ID · Clinical Psychologist in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.