Provider Demographics
NPI:1447572391
Name:GARRETT, LISA (LMH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:LMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2549 QUAIL RUN LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-6121
Mailing Address - Country:US
Mailing Address - Phone:904-252-8916
Mailing Address - Fax:
Practice Address - Street 1:2549 QUAIL RUN LN
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-6121
Practice Address - Country:US
Practice Address - Phone:904-252-8916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7748101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health