Provider Demographics
NPI:1629304803
Name:GARCIA, JUSTIN AARON (BA,BCABA)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:AARON
Last Name:GARCIA
Suffix:
Gender:M
Credentials:BA,BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7639 SPANISH WOOD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4260
Mailing Address - Country:US
Mailing Address - Phone:210-884-8703
Mailing Address - Fax:
Practice Address - Street 1:7639 SPANISH WOOD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-4260
Practice Address - Country:US
Practice Address - Phone:210-884-8703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0-09-3536103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst