Provider Demographics
NPI:1740751619
Name:GARCIA, JIMMY (QMHP-R)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:QMHP-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 SW 4TH ST STE 302
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-9629
Mailing Address - Country:US
Mailing Address - Phone:541-475-6575
Mailing Address - Fax:541-475-6196
Practice Address - Street 1:850 SW 4TH ST STE 302
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-9629
Practice Address - Country:US
Practice Address - Phone:541-475-6575
Practice Address - Fax:541-475-6196
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22-QMHP-R-R-1727101YM0800X
CAR1325701018101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)