Basic Information
| Provider Information | |||||||||
| NPI: | 1073989083 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | JESSE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GARCIA | ||||||||
| OtherFirstName: | JESSIE | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LCSW | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6104 AVE. Q SOUTH DRIVE | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8064723400 | ||||||||
| FaxNumber: | 8064723421 | ||||||||
| Practice Location | |||||||||
| Address1: | 6104 AVE. Q SOUTH DRIVE | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8064723400 | ||||||||
| FaxNumber: | 8064723421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2015 | ||||||||
| LastUpdateDate: | 03/24/2017 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 57269 | TX | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 57269 | TX | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.