Provider Demographics
NPI:1952073249
Name:BAEZA GARCIA, LIZETH CAROLINA
Entity Type:Individual
Prefix:
First Name:LIZETH
Middle Name:CAROLINA
Last Name:BAEZA GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 SHADOW MOUNTAIN DR APT 201A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4031
Mailing Address - Country:US
Mailing Address - Phone:915-691-6541
Mailing Address - Fax:
Practice Address - Street 1:2701 E YANDELL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-3726
Practice Address - Country:US
Practice Address - Phone:915-562-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81757101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health