Provider Demographics
NPI:1467835165
Name:WILLIS GARCES, ANDREW
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:WILLIS GARCES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78722-1006
Mailing Address - Country:US
Mailing Address - Phone:202-277-5262
Mailing Address - Fax:
Practice Address - Street 1:4807 SPICEWOOD SPRINGS RD
Practice Address - Street 2:BLDG 1, #1140
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8444
Practice Address - Country:US
Practice Address - Phone:512-843-7665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70523101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional