Basic Information
| Provider Information | |||||||||
| NPI: | 1194923805 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARRISON | ||||||||
| FirstName: | KERRI | ||||||||
| MiddleName: | KOCHEL | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GARRISON | ||||||||
| OtherFirstName: | KERRI | ||||||||
| OtherMiddleName: | KOCHEL | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LPC | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1707 LINWOOD DR STE G | ||||||||
| Address2: | |||||||||
| City: | PARAGOULD | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724505365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8706044455 | ||||||||
| FaxNumber: | 8889772956 | ||||||||
| Practice Location | |||||||||
| Address1: | 2420 LINWOOD DRIVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | PARAGOULD | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8703359985 | ||||||||
| FaxNumber: | 8702365757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2007 | ||||||||
| LastUpdateDate: | 08/16/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | P0609057 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.