Provider Demographics
NPI:1982797759
Name:GARETT, KENNETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:GARETT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S CIVIC DR
Mailing Address - Street 2:#211
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7226
Mailing Address - Country:US
Mailing Address - Phone:760-327-9566
Mailing Address - Fax:760-323-3190
Practice Address - Street 1:225 S CIVIC DR
Practice Address - Street 2:#211
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7226
Practice Address - Country:US
Practice Address - Phone:760-327-9566
Practice Address - Fax:760-323-3190
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5844103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL58442Medicaid
CA00PL58442Medicaid