MEDICARE: GEORGINA GARNER

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

General Provider Information

NPI Number	:	1184349938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGINA GARNER

Provider Business Mailing Address
First Line	:	3309 WINTHROP AVE STE 74
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-5600
Country	:	US
Telephone Number	:	817-602-5048
Fax Number	:

Provider Business Practice Location Address
First Line	:	3309 WINTHROP AVE STE 74
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-5600
Country	:	US
Telephone Number	:	817-602-5048
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GEORGIA GARNER
Credential	:	PHD, LCP
Telephone Number	:	817-454-0361

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	10/04/2022

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