Healthcare Provider Details

I. General information

NPI: 1801374939
Provider Name (Legal Business Name): SUZANNE GARRETT MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 AIRPORT RD
HOOPA CA
95546
US

IV. Provider business mailing address

PO BOX 1288
HOOPA CA
95546-1288
US

V. Phone/Fax

Practice location:
  • Phone: 530-625-4261
  • Fax:
Mailing address:
  • Phone: 530-625-4261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: