Provider Demographics
NPI:1467524611
Name:GARBOW, MICHAEL JEFFREY (MS LP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JEFFREY
Last Name:GARBOW
Suffix:
Gender:M
Credentials:MS LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 W 96TH ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-2606
Mailing Address - Country:US
Mailing Address - Phone:952-884-4882
Mailing Address - Fax:952-884-0284
Practice Address - Street 1:1206 W 96TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-2606
Practice Address - Country:US
Practice Address - Phone:952-884-4882
Practice Address - Fax:952-884-0284
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1233103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6203243OtherMEDICA HEALTHPLAN
MN120040OtherU-CARE MINNESOTA
MN6291913OtherUNITED BEHAVIORAL HEALTH