Healthcare Provider Details

I. General information

NPI: 1922492420
Provider Name (Legal Business Name): VALERIE JEAN GARRETT M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15720 VENTURA BLVD SUITE 209
ENCINO CA
91436-2914
US

IV. Provider business mailing address

15720 VENTURA BLVD SUITE 209
ENCINO CA
91436-2914
US

V. Phone/Fax

Practice location:
  • Phone: 323-229-6864
  • Fax: 323-851-6200
Mailing address:
  • Phone: 323-229-6864
  • Fax: 323-851-6200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number85874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: