Healthcare Provider Details

I. General information

NPI: 1124865365
Provider Name (Legal Business Name): PATRICIA ANN GARRICK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 SW RANGE DR
WALDPORT OR
97394-9634
US

IV. Provider business mailing address

431 29 1/2 RD
GRAND JUNCTION CO
81504-6478
US

V. Phone/Fax

Practice location:
  • Phone: 541-563-3197
  • Fax:
Mailing address:
  • Phone: 970-250-5265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC8569
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0011174
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: