Healthcare Provider Details

I. General information

NPI: 1841223849
Provider Name (Legal Business Name): GARNETT JESSE BOZELL LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N HOUSTON ST
LORENA TX
76655-9742
US

IV. Provider business mailing address

500 N HOUSTON ST
LORENA TX
76655-9742
US

V. Phone/Fax

Practice location:
  • Phone: 254-297-3505
  • Fax: 254-297-3360
Mailing address:
  • Phone: 254-297-3505
  • Fax: 254-297-3360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number04539
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: