Healthcare Provider Details

I. General information

NPI: 1154231058
Provider Name (Legal Business Name): GARRETT LAWRENCE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19271 SD-79
VALE SD
57788
US

IV. Provider business mailing address

19271 SD-79
VALE SD
57788
US

V. Phone/Fax

Practice location:
  • Phone: 605-309-5105
  • Fax:
Mailing address:
  • Phone: 605-309-5105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: