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General NPI Number Information
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NPI Number | 1891839452
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Entity Type | Individual
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Provider Name | KERRY LEE GARRETSON PH.D.
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Gender | Male
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 6912 SPRING VALLEY DR SUITE 202C
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City | HOLLAND
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State | OH
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Zip | 43528-9676
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Country | US
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Telephone | 419-866-4644
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Fax | 419-861-5040
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Provider Business Mailing Address
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Address Line | 4986 COUNTY ROAD 6 1
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City | DELTA
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State | OH
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Zip | 43515-9241
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2500
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 2500
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License Number State | OH
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