Provider Demographics
NPI:1386752731
Name:GARNER, JOAN W (PSYD)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:W
Last Name:GARNER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MISS
Other - First Name:JOAN
Other - Middle Name:SARI
Other - Last Name:WEINBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1234 N WINDOMERE AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2733
Mailing Address - Country:US
Mailing Address - Phone:214-924-1950
Mailing Address - Fax:
Practice Address - Street 1:1234 N WINDOMERE AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2733
Practice Address - Country:US
Practice Address - Phone:214-924-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22114103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00SD33OtherBCBS
TX115548302Medicaid
TXOOSD33Medicare ID - Type Unspecified
TX115548302Medicaid