Provider Demographics
NPI:1417572165
Name:GARCIA, JESSICA RENEE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-1738
Mailing Address - Country:US
Mailing Address - Phone:719-597-0822
Mailing Address - Fax:
Practice Address - Street 1:7719 DEL RAY BAY ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-1795
Practice Address - Country:US
Practice Address - Phone:719-232-2077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician