Provider Demographics
NPI:1013526011
Name:GARCIA, CLARA LORRAINE (RBT)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:LORRAINE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11028 JOLLYVILLE RD APT 146
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4825
Mailing Address - Country:US
Mailing Address - Phone:512-745-6965
Mailing Address - Fax:
Practice Address - Street 1:11028 JOLLYVILLE RD APT 146
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4825
Practice Address - Country:US
Practice Address - Phone:512-745-6965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician