Provider Demographics
NPI:1740768563
Name:GARCIA, RENE ESTEBAN
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:ESTEBAN
Last Name:GARCIA
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:PO BOX 702744
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75370-2744
Mailing Address - Country:US
Mailing Address - Phone:214-308-1122
Mailing Address - Fax:
Practice Address - Street 1:5168 VILLAGE CREEK DR STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4447
Practice Address - Country:US
Practice Address - Phone:214-308-1122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11850101YA0400X
TX70420101YM0800X
TX201956101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX814939012OtherSTATE OF TEXAS