Provider Demographics
NPI:1275071771
Name:GARCIA, MALLORY (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:
Other - Last Name:WILKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 E 9TH ST STE 302
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6069
Mailing Address - Country:US
Mailing Address - Phone:909-921-9160
Mailing Address - Fax:909-804-5861
Practice Address - Street 1:123 E 9TH ST STE 302
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6069
Practice Address - Country:US
Practice Address - Phone:909-921-9160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-03
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA109864106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor