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

Q: What is the provider's specialty?

The provider's specialty is Licensed Psychiatric Technician with taxonomy code 167G00000X.

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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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