Provider Demographics
NPI:1669791141
Name:GARRETT-SPEARS, LOLA (LBSW)
Entity type:Individual
Prefix:
First Name:LOLA
Middle Name:
Last Name:GARRETT-SPEARS
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2716
Mailing Address - Country:US
Mailing Address - Phone:469-245-9640
Mailing Address - Fax:972-291-1342
Practice Address - Street 1:108 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2716
Practice Address - Country:US
Practice Address - Phone:469-245-9640
Practice Address - Fax:972-291-1342
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2011-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52756171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1669791141Medicaid