1982719035 NPI number — MRS. BONNIE GORE GARNETTE LCSW

Table of content: NACHELLE CROUCH (NPI 1568702785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982719035 NPI number — MRS. BONNIE GORE GARNETTE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARNETTE
Provider First Name:
BONNIE
Provider Middle Name:
GORE
Provider Name Prefix Text:
MRS.
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:
1982719035
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6418 ECKHERT RD
Provider Second Line Business Mailing Address:
APT # 4202
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78240-2896
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-405-1992
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7400 MERTON MINTER BLVD.
Provider Second Line Business Practice Location Address:
SOUTH TEXAS VETERANS HEALTH CARE SYSTEM
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-617-5300
Provider Business Practice Location Address Fax Number:
210-949-3326
Provider Enumeration Date:
08/20/2006

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:  6207 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: C005526 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 9408 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 9408 . This is a "STATE BOARD OF SOCIAL WORK LICENSURE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: C005526 . This is a "STATE BOARD OF SOCIAL WORK LICENSURE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6207 . This is a "STATE BOARD OF SOCIAL WORK LICENSURE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".