Provider Demographics
NPI:1104665579
Name:GARLICK, IAN MICHAEL (LLMSW)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:MICHAEL
Last Name:GARLICK
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 VICTOR DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48609-5135
Mailing Address - Country:US
Mailing Address - Phone:989-781-2881
Mailing Address - Fax:
Practice Address - Street 1:9790 GRATIOT RD STE 5
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48609-9473
Practice Address - Country:US
Practice Address - Phone:989-249-3671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511179671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical