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General NPI Number Information
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NPI Number | 1407292386
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Entity Type | Organization
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Legal Business Name | W.B.GARRETT CONSULTING LLC
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Dates
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Enumeration Date | 05/17/2013
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Last Update Date | 05/17/2013
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Provider Practice Location Address
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Address Line | 570 ASBURY ST 304-A
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City | SAINT PAUL
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State | MN
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Zip | 55104-1849
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Country | US
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Telephone | 651-646-8594
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Fax |
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Provider Business Mailing Address
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Address Line | 570 ASBURY STREET 304-A
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City | ST. PAUL
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State | MN
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Zip | 55104-1949
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Country | US
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Telephone | 651-646-8594
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. WILLIE BERNARD GARRETT
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Credential | ED.D.
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Telephone | 651-646-8594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LP1234
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License Number State | MN
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