Provider Demographics
NPI:1205978608
Name:GARVIN, GARY L (MED, LMHC)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:GARVIN
Suffix:
Gender:M
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 W RIVERSIDE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-1242
Mailing Address - Country:US
Mailing Address - Phone:509-991-7203
Mailing Address - Fax:509-455-5164
Practice Address - Street 1:1614 W RIVERSIDE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-1242
Practice Address - Country:US
Practice Address - Phone:509-991-7203
Practice Address - Fax:509-455-5164
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005537101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health