Provider Demographics
NPI:1578867362
Name:GARRISON, DENNIS JAY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:JAY
Last Name:GARRISON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 TUCKER RD., STE.#G
Mailing Address - Street 2:PMB 258
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561
Mailing Address - Country:US
Mailing Address - Phone:661-972-0478
Mailing Address - Fax:
Practice Address - Street 1:785 TUCKER RD., STE.#G
Practice Address - Street 2:PMB 258
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561
Practice Address - Country:US
Practice Address - Phone:661-972-0478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10889103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical