Healthcare Provider Details

I. General information

NPI: 1497014815
Provider Name (Legal Business Name): JILL DIANE GARMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 NAPA AVE SUITE B-6
MORRO BAY CA
93442-1944
US

IV. Provider business mailing address

PO BOX 319
MORRO BAY CA
93443-0319
US

V. Phone/Fax

Practice location:
  • Phone: 805-704-1679
  • Fax:
Mailing address:
  • Phone: 805-704-1679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCS27950
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS27950
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: