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NPI Code Detail

MEDICARE: HOLLY RAE GARRETT LCSW, RPT

MEDICARE: HOLLY RAE GARRETT LCSW, RPT
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
11041C0700XClinical Social Worker12755TX

General Provider Information

NPI Number : 1942449293
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY RAE GARRETT LCSW, RPT
Provider Business Mailing Address
First Line : 3131 SANGUINET ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-5336
Country : US
Telephone Number : 817-255-2610
Fax Number :
Provider Business Practice Location Address
First Line : 3131 SANGUINET ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-5336
Country : US
Telephone Number : 817-255-2610
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2009
Last Update Date : 02/10/2009

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