Provider Demographics
NPI:1689946048
Name:GARNETT, ERIC KEITH (LADC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:KEITH
Last Name:GARNETT
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7157 COMMERCE CIR W
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-3108
Mailing Address - Country:US
Mailing Address - Phone:763-566-2888
Mailing Address - Fax:763-566-3949
Practice Address - Street 1:7157 COMMERCE CIR W
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3108
Practice Address - Country:US
Practice Address - Phone:763-566-2888
Practice Address - Fax:763-566-3949
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301442101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)