Provider Demographics
NPI:1588966139
Name:KENNETH GARETT PHD INC
Entity type:Organization
Organization Name:KENNETH GARETT PHD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GARETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:760-327-9566
Mailing Address - Street 1:225 S CIVIC DR STE 2-11
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7228
Mailing Address - Country:US
Mailing Address - Phone:760-327-9566
Mailing Address - Fax:
Practice Address - Street 1:225 S CIVIC DR STE 2-11
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7228
Practice Address - Country:US
Practice Address - Phone:760-327-9566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5844261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL58442Medicaid
CAEE014AMedicare PIN