Provider Demographics
NPI:1205870920
Name:GARCIA, JESSIE L (PHD)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:L
Last Name:GARCIA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 N SCOTTSDALE RD
Mailing Address - Street 2:STE 222
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-7077
Mailing Address - Country:US
Mailing Address - Phone:480-784-7561
Mailing Address - Fax:480-784-7561
Practice Address - Street 1:4300 N SCOTTSDALE RD
Practice Address - Street 2:STE 222
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-7077
Practice Address - Country:US
Practice Address - Phone:480-784-7561
Practice Address - Fax:480-784-7561
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3625103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist