Provider Demographics
NPI:1962687244
Name:GARCIA, LISA A (MA,LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E. MAIN SUITE 212
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332
Mailing Address - Country:US
Mailing Address - Phone:361-661-1379
Mailing Address - Fax:361-661-1685
Practice Address - Street 1:1600 E MAIN ST STE 212
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4046
Practice Address - Country:US
Practice Address - Phone:361-661-1379
Practice Address - Fax:361-661-1685
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66787101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1962687244Medicaid