Provider Demographics
NPI:1508898966
Name:GARRETT, KIM PEDEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:PEDEN
Last Name:GARRETT
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 1:2704 PARK PL
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-6324
Mailing Address - Country:US
Mailing Address - Phone:817-774-6098
Mailing Address - Fax:817-556-0052
Practice Address - Street 1:212 N ANGLIN ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76031-4133
Practice Address - Country:US
Practice Address - Phone:817-645-3328
Practice Address - Fax:817-558-3203
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS15573101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health