Provider Demographics
NPI:1558789198
Name:GARCIA, JESSICA (BS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 RIPPLEWOOD
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-6237
Mailing Address - Country:US
Mailing Address - Phone:830-955-2013
Mailing Address - Fax:
Practice Address - Street 1:104 RIPPLEWOOD
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-6237
Practice Address - Country:US
Practice Address - Phone:830-955-2013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0-14-5802103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst