Provider Demographics
NPI:1972729531
Name:CONWAY, GARRET B
Entity Type:Individual
Prefix:
First Name:GARRET
Middle Name:B
Last Name:CONWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MOLINA DR
Mailing Address - Street 2:
Mailing Address - City:BONNY DOON
Mailing Address - State:CA
Mailing Address - Zip Code:95060-9457
Mailing Address - Country:US
Mailing Address - Phone:831-420-7987
Mailing Address - Fax:
Practice Address - Street 1:191 HARVEY WEST BLVD
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2126
Practice Address - Country:US
Practice Address - Phone:831-469-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134308106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist