Basic Information
| Provider Information | |||||||||
| NPI: | 1720417306 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARRETT | ||||||||
| FirstName: | CLAUDIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LADAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2960B OLD AUSTIN PEAY HWY | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381285631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013729898 | ||||||||
| FaxNumber: | 9013739298 | ||||||||
| Practice Location | |||||||||
| Address1: | 2960B OLD AUSTIN PEAY HWY | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381285631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013729898 | ||||||||
| FaxNumber: | 9013739298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2013 | ||||||||
| LastUpdateDate: | 11/05/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LDC0000001011 | TN | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.