Healthcare Provider Details

I. General information

NPI: 1972970812
Provider Name (Legal Business Name): GARNISHA SANFORD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date: 03/10/2025
Reactivation Date: 03/18/2025

III. Provider practice location address

21350 W 153RD ST
OLATHE KS
66061-5413
US

IV. Provider business mailing address

621 ALAINA DR
DESOTO TX
75115-8062
US

V. Phone/Fax

Practice location:
  • Phone: 859-254-1035
  • Fax:
Mailing address:
  • Phone: 502-224-7886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number69103
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: