=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972758050
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | L ALLISON MICHEL GARNIER CAC III
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2008
-----------------------------------------------------
Last Update Date | 11/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 407 PALMER ST
-----------------------------------------------------
City | DELTA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81416-1737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-250-5948
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1083
-----------------------------------------------------
City | CEDAREDGE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81413-1083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-250-5948
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 5385
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------