Basic Information
| Provider Information | |||||||||
| NPI: | 1699315663 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARRETT | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | MA, COBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3500 DEPAUW BLVD, SUITE 3070 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46268 | ||||||||
| CountryCode: | UM | ||||||||
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| Practice Location | |||||||||
| Address1: | 9260 MARKETPLACE DRIVE | ||||||||
| Address2: | |||||||||
| City: | MIAMISBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373885110 | ||||||||
| FaxNumber: | 3175208200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2020 | ||||||||
| LastUpdateDate: | 12/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | COBA.00769 | OH | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.