Basic Information
| Provider Information | |||||||||
| NPI: | 1154816304 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARDNER | ||||||||
| FirstName: | MERRILEE | ||||||||
| MiddleName: | CHRISTINE | ||||||||
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| Credential: | M.ED | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2569 | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982130569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252124200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 811 MADISON ST | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252124200 | ||||||||
| FaxNumber: | 4252124201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2018 | ||||||||
| LastUpdateDate: | 06/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | WA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.