Provider Demographics
NPI:1841223849
Name:BOZELL, GARNETT JESSE (LMSW)
Entity Type:Individual
Prefix:
First Name:GARNETT
Middle Name:JESSE
Last Name:BOZELL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:LORENA
Mailing Address - State:TX
Mailing Address - Zip Code:76655-9742
Mailing Address - Country:US
Mailing Address - Phone:254-297-3505
Mailing Address - Fax:254-297-3360
Practice Address - Street 1:500 N HOUSTON ST
Practice Address - Street 2:
Practice Address - City:LORENA
Practice Address - State:TX
Practice Address - Zip Code:76655-9742
Practice Address - Country:US
Practice Address - Phone:254-297-3505
Practice Address - Fax:254-297-3360
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04539104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker