Provider Demographics
NPI:1700291713
Name:GARRARD, BRENT CHRISTOPHER (LPCC)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:CHRISTOPHER
Last Name:GARRARD
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4524 BARRINGTON PL
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-7907
Mailing Address - Country:US
Mailing Address - Phone:270-925-7857
Mailing Address - Fax:
Practice Address - Street 1:2816 VEACH ROAD
Practice Address - Street 2:SUITE 208
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-6299
Practice Address - Country:US
Practice Address - Phone:270-929-6331
Practice Address - Fax:270-228-0318
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1726101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100301860Medicaid