Provider Demographics
NPI:1417120817
Name:GARNER, DOUGLAS (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:GARNER
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 E PALMDALE BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4853
Mailing Address - Country:US
Mailing Address - Phone:661-947-0137
Mailing Address - Fax:
Practice Address - Street 1:1305 E PALMDALE BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4853
Practice Address - Country:US
Practice Address - Phone:661-947-0137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC022672106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist