Provider Demographics
NPI:1861515850
Name:GARRETT, JEFFREY S (PSYD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:GARRETT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S KRAEMER BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-6105
Mailing Address - Country:US
Mailing Address - Phone:714-577-0400
Mailing Address - Fax:714-577-0408
Practice Address - Street 1:101 S KRAEMER BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6105
Practice Address - Country:US
Practice Address - Phone:714-577-0400
Practice Address - Fax:714-577-0408
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 16695103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical