Provider Demographics
NPI:1265951776
Name:GARMON, WILLIAM WAYNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WAYNE
Last Name:GARMON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:WAYNE
Other - Last Name:GARMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BILLY WAYNE GARMON
Mailing Address - Street 1:1333 S BELARDO RD APT 511
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-8312
Mailing Address - Country:US
Mailing Address - Phone:760-320-5275
Mailing Address - Fax:760-778-9987
Practice Address - Street 1:1111 TAHQUITZ CANYON WAY/SUITE 121
Practice Address - Street 2:SUITE 121
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-8312
Practice Address - Country:US
Practice Address - Phone:760-322-0584
Practice Address - Fax:760-778-9987
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10450103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$OtherWILLIAM GARMON