Healthcare Provider Details

I. General information

NPI: 1225503063
Provider Name (Legal Business Name): GARRICK FRANCIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4722 RIVERSTONE BLVD STE 100
MISSOURI CITY TX
77459-4723
US

IV. Provider business mailing address

4722 RIVERSTONE BLVD STE 100
MISSOURI CITY TX
77459-4723
US

V. Phone/Fax

Practice location:
  • Phone: 346-368-4412
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-58522
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: