Healthcare Provider Details

I. General information

NPI: 1497888622
Provider Name (Legal Business Name): JESSICA DEANN GARNER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 OWENSMOUTH AVE
CANOGA PARK CA
91303-3159
US

IV. Provider business mailing address

6800 OWENSMOUTH AVE STE 160
CANOGA PARK CA
91303-4255
US

V. Phone/Fax

Practice location:
  • Phone: 213-926-9638
  • Fax:
Mailing address:
  • Phone: 213-926-9638
  • Fax: 818-347-8736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number26303
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW29802
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29802
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: