=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174074975
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES B GARRISON LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2016
-----------------------------------------------------
Last Update Date | 09/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5005 HONONEGAH RD UNIT 1
-----------------------------------------------------
City | ROSCOE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61073-8682
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 779-269-4011
-----------------------------------------------------
Fax | 779-771-6343
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1324 CAMP AVE
-----------------------------------------------------
City | ROCKFORD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-222-1679
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 149024297
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------