Provider Demographics
NPI:1942824511
Name:GARCIA, KELLIE (MA, LPC, RPT)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MA, LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S CARROLL BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-6859
Mailing Address - Country:US
Mailing Address - Phone:940-202-9719
Mailing Address - Fax:
Practice Address - Street 1:701 S CARROLL BLVD STE 206
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-6859
Practice Address - Country:US
Practice Address - Phone:940-202-9719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72530101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health