Basic Information
| Provider Information | |||||||||
| NPI: | 1396272050 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARRETT | ||||||||
| FirstName: | JANAE | ||||||||
| MiddleName: | SHANTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2447 NEBRASKA AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436073531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192554444 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2447 NEBRASKA AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436073531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192554444 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2017 | ||||||||
| LastUpdateDate: | 05/12/2017 | ||||||||
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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 | SU930692 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.