Healthcare Provider Details

I. General information

NPI: 1861384802
Provider Name (Legal Business Name): ALFRED LEE GARRETT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5056 VALLEY HI DR
SACRAMENTO CA
95823-5157
US

IV. Provider business mailing address

5056 VALLEY HI DR
SACRAMENTO CA
95823-5157
US

V. Phone/Fax

Practice location:
  • Phone: 916-410-5126
  • Fax:
Mailing address:
  • Phone: 916-410-5126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License NumberC4125055
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberC4125055
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: