Provider Demographics
NPI:1811629827
Name:GARRETT, NATHAN LEE (EDS, NCSP)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:LEE
Last Name:GARRETT
Suffix:
Gender:M
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:LENNOX
Mailing Address - State:SD
Mailing Address - Zip Code:57039-2292
Mailing Address - Country:US
Mailing Address - Phone:605-647-2203
Mailing Address - Fax:605-647-2201
Practice Address - Street 1:305 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:LENNOX
Practice Address - State:SD
Practice Address - Zip Code:57039-2292
Practice Address - Country:US
Practice Address - Phone:605-647-2203
Practice Address - Fax:605-647-2201
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool