MEDICARE: GARRETT BENJAMIN ANTHONY MA, LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	097555	IA

General Provider Information

NPI Number	:	1295382141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARRETT BENJAMIN ANTHONY MA, LMHC

Provider Business Mailing Address
First Line	:	125 PAULAIRE CT
Second Line	:
City	:	BURLINGTON
State	:	IA
Zip	:	52601-1939
Country	:	US
Telephone Number	:	317-517-5478
Fax Number	:

Provider Business Practice Location Address
First Line	:	1014 AVENUE H STE 1
Second Line	:
City	:	FORT MADISON
State	:	IA
Zip	:	52627-4507
Country	:	US
Telephone Number	:	319-372-7689
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2019
Last Update Date	:	08/23/2019

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