Healthcare Provider Details

I. General information

NPI: 1578867362
Provider Name (Legal Business Name): DENNIS JAY GARRISON PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 TUCKER RD., STE.#G PMB 258
TEHACHAPI CA
93561
US

IV. Provider business mailing address

785 TUCKER RD., STE.#G PMB 258
TEHACHAPI CA
93561
US

V. Phone/Fax

Practice location:
  • Phone: 661-972-0478
  • Fax:
Mailing address:
  • Phone: 661-972-0478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10889
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: