Kerry Lee Garretson, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2500 Issued in OH

Practice address

6912 Spring Valley Dr
Suite 202C
Holland, OH 43528-9676

Phone

(419) 866-4644

Fax

(419) 861-5040

NPI assigned

Feb 16, 2007

Last updated

Oct 27, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kerry L. Garretson, PH.D.

  • Psychologist
  • Holland, OH
  • NPI 1275821514
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319673600000",
    "number": "1891839452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4986 COUNTY ROAD 6 1",
            "city": "DELTA",
            "state": "OH",
            "postal_code": "435159241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6912 SPRING VALLEY DR",
            "address_2": "SUITE 202C",
            "city": "HOLLAND",
            "state": "OH",
            "postal_code": "435289676",
            "telephone_number": "419-866-4644",
            "fax_number": "419-861-5040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARRETSON",
        "first_name": "KERRY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-16",
        "last_updated": "2011-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OH",
            "license": "2500",
            "primary": true
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "OH",
            "license": "2500",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0528003",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Holland, OH
• Providers in Holland, OH by specialty
• Psychologist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.