Provider Demographics
NPI:1861384802
Name:GARRETT, ALFRED LEE
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:LEE
Last Name:GARRETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5056 VALLEY HI DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5157
Mailing Address - Country:US
Mailing Address - Phone:916-410-5126
Mailing Address - Fax:
Practice Address - Street 1:5056 VALLEY HI DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5157
Practice Address - Country:US
Practice Address - Phone:916-410-5126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC4125055103TE1100X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports