Provider Demographics
NPI:1114481397
Name:GARRETT, ERNEST EDWARD III (LCSW, LICSW)
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:EDWARD
Last Name:GARRETT
Suffix:III
Gender:M
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 CONVENTION ST APT 507
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70802-5645
Mailing Address - Country:US
Mailing Address - Phone:573-837-1625
Mailing Address - Fax:
Practice Address - Street 1:1026 NORTHEAST DR STE B
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-2517
Practice Address - Country:US
Practice Address - Phone:573-353-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500808151041C0700X
WI8370-1231041C0700X
MO20110089121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496591702Medicaid