Provider Demographics
NPI:1831232974
Name:GARRETT, MICHELLE M (EDS,JD)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:M
Last Name:GARRETT
Suffix:
Gender:F
Credentials:EDS,JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 N MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1305
Mailing Address - Country:US
Mailing Address - Phone:520-232-8200
Mailing Address - Fax:520-232-8201
Practice Address - Street 1:755 N MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1305
Practice Address - Country:US
Practice Address - Phone:520-232-8200
Practice Address - Fax:520-232-8201
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103T00000X103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool