Provider Demographics
NPI:1093491177
Name:GARRETT, ANNIKA RAE (AMFT)
Entity Type:Individual
Prefix:
First Name:ANNIKA
Middle Name:RAE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 MOBIL AVE STE 207A
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-6372
Mailing Address - Country:US
Mailing Address - Phone:805-504-6967
Mailing Address - Fax:
Practice Address - Street 1:360 MOBIL AVE STE 207A
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6372
Practice Address - Country:US
Practice Address - Phone:805-504-6967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA136387106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist