MEDICARE: MS. DOROTHEA A GARRETT LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0928	MS

General Provider Information

NPI Number	:	1003904343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DOROTHEA A GARRETT LPC

Provider Business Mailing Address
First Line	:	2540 FLOWOOD DR # 205A
Second Line	:	P.O. BOX 321026
City	:	FLOWOOD
State	:	MS
Zip	:	39232-9362
Country	:	US
Telephone Number	:	601-594-7233
Fax Number	:

Provider Business Practice Location Address
First Line	:	2540 FLOWOOD DR
Second Line	:	SUITE A 205
City	:	FLOWOOD
State	:	MS
Zip	:	39232-9362
Country	:	US
Telephone Number	:	601-594-7233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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