Provider Demographics
NPI:1073960548
Name:MARY GARCIA, M.S., CCC-SLP, PLLC
Entity Type:Organization
Organization Name:MARY GARCIA, M.S., CCC-SLP, PLLC
Other - Org Name:WEST TEXAS SPEECH THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:432-214-1218
Mailing Address - Street 1:1722 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-2917
Mailing Address - Country:US
Mailing Address - Phone:432-214-1218
Mailing Address - Fax:
Practice Address - Street 1:850 TOWER DR
Practice Address - Street 2:SUITE 112
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4238
Practice Address - Country:US
Practice Address - Phone:432-214-1218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104558235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1437421666OtherNPI TYPE 1
TX354674901Medicaid