Provider Demographics
NPI:1932893013
Name:GARRETT, LETITIA SHEVON
Entity type:Individual
Prefix:MS
First Name:LETITIA
Middle Name:SHEVON
Last Name:GARRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9702 W FERRIS BRANCH BLVD APT 532
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-8719
Mailing Address - Country:US
Mailing Address - Phone:773-981-2679
Mailing Address - Fax:
Practice Address - Street 1:9702 W FERRIS BRANCH BLVD APT 532
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-8719
Practice Address - Country:US
Practice Address - Phone:773-981-2679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX326176183700000X
320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No183700000XPharmacy Service ProvidersPharmacy Technician