MEDICARE: MEREDITH GARRISON LMSW, LCDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	12762	TX
2	104100000X	Social Worker	56653	TX
3	1041C0700X	Clinical Social Worker	56653	TX

General Provider Information

NPI Number	:	1194104430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEREDITH GARRISON LMSW, LCDC

Provider Business Mailing Address
First Line	:	4223 LOMO ALTO CT
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-1508
Country	:	US
Telephone Number	:	214-460-5168
Fax Number	:

Provider Business Practice Location Address
First Line	:	4223 LOMO ALTO CT
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-1508
Country	:	US
Telephone Number	:	214-460-5168
Fax Number	:

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

Provider Enumeration Date	:	05/19/2015
Last Update Date	:	04/26/2023

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