Provider Demographics
NPI:1497014815
Name:GARMAN, JILL DIANE (LCSW)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:DIANE
Last Name:GARMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 319
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93443-0319
Mailing Address - Country:US
Mailing Address - Phone:805-704-1679
Mailing Address - Fax:
Practice Address - Street 1:895 NAPA AVE
Practice Address - Street 2:SUITE B-6
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-1944
Practice Address - Country:US
Practice Address - Phone:805-704-1679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS27950101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS 27950OtherBOARD OF BEHAVIORAL SCIENCES LICENSE