Provider Demographics
NPI:1013583376
Name:GARCILAZO, RAQUEL ANN (CASE MANAGEMENT)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:ANN
Last Name:GARCILAZO
Suffix:
Gender:F
Credentials:CASE MANAGEMENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21455 RUSTY LN
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-4261
Mailing Address - Country:US
Mailing Address - Phone:956-778-6886
Mailing Address - Fax:
Practice Address - Street 1:315 E JACKSON ST STE 4
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-6849
Practice Address - Country:US
Practice Address - Phone:956-778-6886
Practice Address - Fax:210-618-0324
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81996101YM0800X, 101YP2500X, 171M00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator