Healthcare Provider Details

I. General information

NPI: 1639091366
Provider Name (Legal Business Name): JESSICA LEE GARRITY RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12319 HIGHLAND RD STE 301
HARTLAND MI
48353-2946
US

IV. Provider business mailing address

3515 EMERALD PARK DR
MILFORD MI
48380-3358
US

V. Phone/Fax

Practice location:
  • Phone: 248-714-8445
  • Fax: 248-918-2880
Mailing address:
  • Phone: 586-201-4593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberG630403497635
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: