Provider Demographics
NPI:1013339092
Name:GARNER-OSTEN, GRADY L (PHD)
Entity Type:Individual
Prefix:DR
First Name:GRADY
Middle Name:L
Last Name:GARNER-OSTEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:GRADY
Other - Middle Name:L
Other - Last Name:GARNER
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1700 W IRVING PARK RD
Mailing Address - Street 2:STE #301
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2559
Mailing Address - Country:US
Mailing Address - Phone:773-401-1607
Mailing Address - Fax:
Practice Address - Street 1:1700 W IRVING PARK RD
Practice Address - Street 2:STE #301
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2559
Practice Address - Country:US
Practice Address - Phone:773-401-1607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling