Provider Demographics
NPI:1013029339
Name:GARRETT, RANDALL THOMAS (MS)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:THOMAS
Last Name:GARRETT
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N ASH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-5042
Mailing Address - Country:US
Mailing Address - Phone:509-535-3990
Mailing Address - Fax:509-534-9293
Practice Address - Street 1:1201 N ASH ST STE 201
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-5042
Practice Address - Country:US
Practice Address - Phone:509-535-3990
Practice Address - Fax:509-534-9293
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004310101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health