Healthcare Provider Details

I. General information

NPI: 1487799755
Provider Name (Legal Business Name): DIANNA M. GARBETT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15301 WARREN SHINGLE ROAD 9 MDOS SGOHF
BEALE AFB CA
95903-1907
US

IV. Provider business mailing address

15301 WARREN SHINGLE ROAD 9 MDOS SGOHF
BEALE AFB CA
95903-1907
US

V. Phone/Fax

Practice location:
  • Phone: 530-634-3423
  • Fax: 530-634-0670
Mailing address:
  • Phone: 530-634-3423
  • Fax: 530-634-0670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number224
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: