MEDICARE: MR. COREY F GARBER LPC, SAC-T

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	101Y00000X	Counselor	2907125	WI
2	101Y00000X	Counselor	2907-125	WI
3	104100000X	Social Worker	16385-130	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053410464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. COREY F GARBER LPC, SAC-T

Provider Business Mailing Address
First Line	:	10532 N PORT WASHINGTON RD
Second Line	:	SUITE 1B
City	:	MEQUON
State	:	WI
Zip	:	53092-5563
Country	:	US
Telephone Number	:	262-242-3810
Fax Number	:	262-242-3816

Provider Business Practice Location Address
First Line	:	10532 N. PORT WASHINGTON RD.
Second Line	:	SUITE 1B
City	:	MEQUON
State	:	WI
Zip	:	53092-5563
Country	:	US
Telephone Number	:	262-242-3810
Fax Number	:	262-242-3816

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	05/24/2012

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Directions to “ MR. COREY F GARBER LPC, SAC-T” Practice Location

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