Lee Ray Gardner Jr.

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

R1463650322 Issued in CA

Practice address

160 E Virginia St Ste 100
San Jose, CA 95112-5865

Phone

(408) 938-2113

Fax

(408) 977-1136

NPI assigned

Feb 13, 2007

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1871635235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 E VIRGINIA ST STE 100",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951125865",
            "telephone_number": "408-457-7100",
            "fax_number": "408-977-1136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 E VIRGINIA ST STE 100",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951125865",
            "telephone_number": "408-938-2113",
            "fax_number": "408-977-1136"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "150A South Autumn Street",
            "address_2": "Employment Services",
            "address_purpose": "LOCATION",
            "city": "San Jose",
            "state": "CA",
            "postal_code": "951102515",
            "country_code": "US",
            "telephone_number": "408-938-8500",
            "fax_number": "408-286-8988",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "LEE",
        "middle_name": "RAY",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2023-03-07",
        "certification_date": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "R1463650322",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gardner Family Health Network Inc
• Gardner Family Health Network Inc (Yerba Buena High School)
• Gardner Family Health Network Inc
• Gardner Family Health Network, Inc. (Gardner Specialty Service Center)
• Brian Louis Gardner, RCP
• Nicola Louise Gardner
• Portia Gardner
• Garfield Beach CVS LLC (CVS Pharmacy #17588)
• Garfield Beach CVS LLC (CVS Pharmacy #17582)
• Garfield Beach CVS LLC (CVS Pharmacy #17314)

• Addiction (Substance Use Disorder) Counselor in San Jose, CA
• Providers in San Jose, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.