Provider Demographics
NPI:1730950205
Name:GARRETT, MARY (MA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11492 S 3420 W
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8159
Mailing Address - Country:US
Mailing Address - Phone:360-951-0454
Mailing Address - Fax:
Practice Address - Street 1:563 W 500 S STE 220
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-8289
Practice Address - Country:US
Practice Address - Phone:801-462-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13746237-6010101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health