Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 2712 | AL |
NPI | 1114575933 |
---|---|
Provider Name | Mr. Garrett Irby |
First Address | Hoover, AL 35226-3007 |
Second Address | Hoover, AL 35226-3007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2019 |
Last Update Date | 27/08/2019 |