Provider Demographics
NPI:1912765876
Name:GARNETT, TABITHA KAYE (CSWA)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:KAYE
Last Name:GARNETT
Suffix:
Gender:F
Credentials:CSWA
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5202 SW OLIVIA PL
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-2502
Mailing Address - Country:US
Mailing Address - Phone:503-330-5846
Mailing Address - Fax:
Practice Address - Street 1:5240 NE ELAM YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6437
Practice Address - Country:US
Practice Address - Phone:503-846-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA11646101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor