=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295397040
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN GARRISON CDCA, LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2019
-----------------------------------------------------
Last Update Date | 07/02/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3621 ROSSGATE CT
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45013-9558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-738-7600
-----------------------------------------------------
Fax | 513-738-7601
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3621 ROSSGATE CT
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45013-9558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-738-7600
-----------------------------------------------------
Fax | 513-738-7601
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN.328476
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | CDCA.168281
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------