1902920879 NPI number — GRETCHEN HOLMES GARRETT LCSW

Table of content: GRETCHEN HOLMES GARRETT LCSW (NPI 1902920879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902920879 NPI number — GRETCHEN HOLMES GARRETT LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARRETT
Provider First Name:
GRETCHEN
Provider Middle Name:
HOLMES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902920879
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 E ITHICA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78501-9067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-994-1718
Provider Business Mailing Address Fax Number:
956-994-1714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 W NOLANA ST
Provider Second Line Business Practice Location Address:
SUITE 14
Provider Business Practice Location Address City Name:
MCALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78504-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-994-1718
Provider Business Practice Location Address Fax Number:
956-994-1714
Provider Enumeration Date:
03/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  S02627 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: S02627 . This is a "STATE LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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