Basic Information
| Provider Information | |||||||||
| NPI: | 1861052201 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARCIA | ||||||||
| FirstName: | E'LEYNA | ||||||||
| MiddleName: | K | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 650859 DEPT 710 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752653518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097720620 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 N TEXAS AVE STE A | ||||||||
| Address2: | |||||||||
| City: | WEBSTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775984961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813382798 | ||||||||
| FaxNumber: | 2815572097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2019 | ||||||||
| LastUpdateDate: | 03/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 39023 | TX | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.