Healthcare Provider Details

I. General information

NPI: 1932639275
Provider Name (Legal Business Name): JESSICA GARRETT MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 BLACK TAIL DR
SACRAMENTO CA
95823-6021
US

IV. Provider business mailing address

81 DEAN RD APT 8
SACRAMENTO CA
95815-3740
US

V. Phone/Fax

Practice location:
  • Phone: 916-949-3660
  • Fax:
Mailing address:
  • Phone: 279-209-6553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: