GARDNER CARLSON
NPI 1063977460
Licensed Psychiatric Technician in Santa Rosa, CA

Q: What is Gardner Carlson's NPI number?

The NPI number for Gardner Carlson is 1063977460. It was assigned to this individual provider in the NPPES registry on February 10, 2019.

Q: What is Gardner Carlson's specialty?

The primary specialty registered for this NPI is Licensed Psychiatric Technician with taxonomy code 167G00000X.

Q: When was this NPI record last updated?

The NPPES record for Gardner Carlson was last updated on February 10, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since February 10, 2019

2225 CHALLENGER WAY, SANTA ROSA, CA 95407(707) 565-4970(707) 565-5183 Get Directions Write a Review

NPPES record last updated: February 10, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Gardner Carlson NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GARDNER CARLSON (NPI 1063977460) is an individual licensed psychiatric technician in Santa Rosa, California, licensed in California (31251) and active in the NPI registry since February 2019.

NPPES Registry Identity

NPI1063977460

Entity TypeIndividualMale

Primary Taxonomy167G00000X

Provider Legal NameGARDNER CARLSON

Location Address2225 CHALLENGER WAYSanta Rosa, CA 95407-5441

Mailing Address2225 Challenger WaySanta Rosa, CA 95407-5441 · (707) 565-4970 · Fax (707) 565-5183

Phone(707) 565-4970

Fax(707) 565-5183

Sole ProprietorNo

Enumeration DateFebruary 10, 2019

✔ NPI 1063977460 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyLicensed Psychiatric TechnicianNursing Service Providers

Taxonomy Code167G00000X

License✔ Licensed in CA · 31251

Definition

An individual licensed by the state board as a Psychiatric Technician based upon completion of a prescribed course of theory and clinical practice, with two thirds of the clinical practice time focused on mental and developmental disorders. The psychiatric technician practices under the direct supervision of a physician, psychologist, registered nurse or other professional to provide care to patients with mental disorders and developmental disabilities.

2225 CHALLENGER WAY, Santa Rosa, CA 95407

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

RACHEL J AVILA

Counselor (Addiction (Substance Use Disorder))