| Madeline V Gardiner | |
|
30107 Saw Grass Trail Georgetown TX 78628-1139 | |
| (737) 286-8275 | |
| Not Available |
| Full Name | Madeline V Gardiner |
|---|---|
| Speciality | Counselor |
| Location | 30107 Saw Grass Trail, Georgetown, Texas |
| Authorized Official Name and Position | Vicki Gardiner (OWNER) |
| Authorized Official Contact | 7372868275 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Madeline V Gardiner 30107 Saw Grass Trail Georgetown TX 78628-1139 Ph: () - | Madeline V Gardiner 30107 Saw Grass Trail Georgetown TX 78628-1139 Ph: (737) 286-8275 |
| NPI Number | 1285456285 |
|---|---|
| Provider Enumeration Date | 10/30/2024 |
| Last Update Date | 10/30/2024 |
| Certification Date | 10/25/2024 |
| Medicare PECOS PAC ID | 3476087529 |
|---|---|
| Medicare Enrollment ID | O20241112001433 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285456285 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Madeline V Gardiner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1184383002 PECOS PAC ID: 2062946122 Enrollment ID: I20241112002102 |
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