Provider Demographics
NPI:1306978200
Name:NYBECK-GARCIA, PATTI A (LADC)
Entity type:Individual
Prefix:MS
First Name:PATTI
Middle Name:A
Last Name:NYBECK-GARCIA
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 PLUM ST
Mailing Address - Street 2:ARMORY CENTER SUITE 220
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-2351
Mailing Address - Country:US
Mailing Address - Phone:651-385-0600
Mailing Address - Fax:651-388-2129
Practice Address - Street 1:69 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3453
Practice Address - Country:US
Practice Address - Phone:507-454-2839
Practice Address - Fax:507-454-5864
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302063101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)