Provider Demographics
NPI:1568771285
Name:GARVIN, SARRAH (PCC)
Entity Type:Individual
Prefix:
First Name:SARRAH
Middle Name:
Last Name:GARVIN
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 DIXIE HWY STE 415
Mailing Address - Street 2:
Mailing Address - City:FT WRIGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2766
Mailing Address - Country:US
Mailing Address - Phone:859-391-2681
Mailing Address - Fax:
Practice Address - Street 1:1717 DIXIE HWY STE 415
Practice Address - Street 2:
Practice Address - City:FT WRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41011-2766
Practice Address - Country:US
Practice Address - Phone:859-391-2681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103116101YP2500X
OHC.0500396101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100329600Medicaid