Provider Demographics
NPI:1649322892
Name:GARRETT, NOLAN WAYNE (LPC)
Entity type:Individual
Prefix:MR
First Name:NOLAN
Middle Name:WAYNE
Last Name:GARRETT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 N 25TH ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-3318
Mailing Address - Country:US
Mailing Address - Phone:254-741-1883
Mailing Address - Fax:254-741-1883
Practice Address - Street 1:2200 N 25TH ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-3318
Practice Address - Country:US
Practice Address - Phone:254-741-1883
Practice Address - Fax:254-741-1883
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14916101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095862102Medicaid