Healthcare Provider Details

I. General information

NPI: 1235346743
Provider Name (Legal Business Name): CHARLES PATRICK GARRICK LCP. LCAC, TTS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S MAIN ST
OTTAWA KS
66067-3315
US

IV. Provider business mailing address

901 S MAIN ST
OTTAWA KS
66067-3315
US

V. Phone/Fax

Practice location:
  • Phone: 913-521-6300
  • Fax: 913-521-6301
Mailing address:
  • Phone: 913-521-6300
  • Fax: 913-521-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberLCAC00846
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1444
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1444
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number1444
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: