Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY 22855 | CA |
Y | 103T00000X | Psychologist | PSY 22855 | CA |
NPI | 1013119833 |
---|---|
Provider Name | Dr. Julie Anne Garrison |
First Address | South Lake Tahoe, CA 96150 |
Second Address | South Lake Tahoe, CA 96150 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 14/10/2009 |