Basic Information
| Provider Information | |||||||||
| NPI: | 1629408752 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARRETT | ||||||||
| FirstName: | ROBERTA | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | GARRETT | ||||||||
| OtherFirstName: | ROBERTA | ||||||||
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| OtherCredential: | LSW, CACIII | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 1208 | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814021208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703274449 | ||||||||
| FaxNumber: | 9703274676 | ||||||||
| Practice Location | |||||||||
| Address1: | 1350 ASPEN ST. | ||||||||
| Address2: | SUITE B | ||||||||
| City: | NORWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 81423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703274449 | ||||||||
| FaxNumber: | 9703274676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2013 | ||||||||
| LastUpdateDate: | 11/27/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 6575 | CO | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 104100000X | 9920262 | CO | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.