Healthcare Provider Details

I. General information

NPI: 1881119030
Provider Name (Legal Business Name): MYLEKA GARNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 N ST # 13339
SACRAMENTO CA
95816-5712
US

IV. Provider business mailing address

2108 N ST # 13339
SACRAMENTO CA
95816-5712
US

V. Phone/Fax

Practice location:
  • Phone: 831-521-9273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13761
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-23148
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number133207
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT-15987
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: