Provider Demographics
NPI:1265779300
Name:GARRETT, PAMELA M
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:GARRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3736 KYLE SPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-5155
Mailing Address - Country:US
Mailing Address - Phone:702-604-4595
Mailing Address - Fax:888-441-0758
Practice Address - Street 1:3736 KYLE SPRINGS CIR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-5155
Practice Address - Country:US
Practice Address - Phone:702-604-4595
Practice Address - Fax:888-441-0758
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor