Provider Demographics
NPI:1114481397
Name:GARRETT, ERNEST EDWARD III (LCSW, LICSW)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:EDWARD
Last Name:GARRETT
Suffix:III
Gender:M
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 LINDELL BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-3739
Mailing Address - Country:US
Mailing Address - Phone:314-866-8116
Mailing Address - Fax:314-639-9996
Practice Address - Street 1:4625 LINDELL BLVD FL 2
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-3739
Practice Address - Country:US
Practice Address - Phone:314-866-8116
Practice Address - Fax:314-639-9996
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA162521041C0700X
AL4838C1041C0700X
WI8370-1231041C0700X
DCLC500808151041C0700X
MO20110089121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496591702Medicaid