Basic Information
| Provider Information | |||||||||
| NPI: | 1275804163 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARVIN | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805505989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706743158 | ||||||||
| FaxNumber: | 9706865118 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805505989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706743158 | ||||||||
| FaxNumber: | 9706865118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2012 | ||||||||
| LastUpdateDate: | 01/23/2014 | ||||||||
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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 | 1041C0700X | 1743 | CO | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.