Provider Demographics
NPI:1184349938
Name:GEORGINA GARNER
Entity type:Organization
Organization Name:GEORGINA GARNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCP
Authorized Official - Phone:817-454-0361
Mailing Address - Street 1:3309 WINTHROP AVE STE 74
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-5600
Mailing Address - Country:US
Mailing Address - Phone:817-602-5048
Mailing Address - Fax:
Practice Address - Street 1:3309 WINTHROP AVE STE 74
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5600
Practice Address - Country:US
Practice Address - Phone:817-602-5048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty