Provider Demographics
NPI:1235346743
Name:GARRICK, CHARLES PATRICK (LCP LCAC, TTS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:PATRICK
Last Name:GARRICK
Suffix:
Gender:M
Credentials:LCP LCAC, TTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 STATE HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:OSAWATOMIE
Mailing Address - State:KS
Mailing Address - Zip Code:66064-1813
Mailing Address - Country:US
Mailing Address - Phone:913-755-7165
Mailing Address - Fax:
Practice Address - Street 1:1121 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-1503
Practice Address - Country:US
Practice Address - Phone:803-599-0129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCAC00846103TA0400X
KS1444103TB0200X, 103TC0700X
1444103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy