Provider Demographics
NPI:1972094019
Name:GARCIA, MARY M (MA, PLMHP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MA, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 SOUTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4267
Mailing Address - Country:US
Mailing Address - Phone:402-657-2615
Mailing Address - Fax:
Practice Address - Street 1:10846 JOHN GALT BLVD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2306
Practice Address - Country:US
Practice Address - Phone:402-325-1290
Practice Address - Fax:402-817-4894
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11970101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026768800Medicaid