Provider Demographics
NPI:1760765549
Name:GARETY JAMES, CASSIE DEE (PHD)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:DEE
Last Name:GARETY JAMES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 WASHTENAW AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4526
Mailing Address - Country:US
Mailing Address - Phone:734-545-8841
Mailing Address - Fax:
Practice Address - Street 1:2350 WASHTENAW AVE STE 3
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4526
Practice Address - Country:US
Practice Address - Phone:734-545-8841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIG630108139199390200000X
MI6301016753103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program