Provider Demographics
NPI:1437289915
Name:GARRISON, JEROME HOSEA (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JEROME
Middle Name:HOSEA
Last Name:GARRISON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10506 STONEBREAKER RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-4024
Mailing Address - Country:US
Mailing Address - Phone:502-930-3853
Mailing Address - Fax:
Practice Address - Street 1:2210 MEADOW DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1323
Practice Address - Country:US
Practice Address - Phone:502-384-6009
Practice Address - Fax:502-384-1002
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0339106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist