MEDICARE: VIRGINIA 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	1041C0700X	Clinical Social Worker	LPC12111	AZ
2	101Y00000X	Counselor	LPC-1211	AZ
3	101YM0800X	Mental Health Counselor	LPC-1211	AZ

General Provider Information

NPI Number	:	1831469055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA GARNER

Provider Business Mailing Address
First Line	:	6280 E PIMA ST
Second Line	:	SUITE 110
City	:	TUCSON
State	:	AZ
Zip	:	85712-3074
Country	:	US
Telephone Number	:	520-820-6740
Fax Number	:

Provider Business Practice Location Address
First Line	:	6280 E PIMA ST
Second Line	:	SUITE 110
City	:	TUCSON
State	:	AZ
Zip	:	85712-3074
Country	:	US
Telephone Number	:	520-820-6740
Fax Number	:

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

Provider Enumeration Date	:	01/04/2012
Last Update Date	:	10/08/2012

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Directions to “ VIRGINIA GARNER ” Practice Location

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