Provider Demographics
NPI:1174758940
Name:GARNER, DOUGLAS L (PHD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:L
Last Name:GARNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3913 SCOTSMAN WAY
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-7606
Mailing Address - Country:US
Mailing Address - Phone:702-399-0448
Mailing Address - Fax:
Practice Address - Street 1:3913 SCOTSMAN WAY
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-7606
Practice Address - Country:US
Practice Address - Phone:702-399-0448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0000056722320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness