Provider Demographics
NPI:1376383612
Name:GARCIA LEZAMA, GENESIS G
Entity type:Individual
Prefix:
First Name:GENESIS
Middle Name:G
Last Name:GARCIA LEZAMA
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 1:1101 VINE AVE STE A&B
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-4079
Mailing Address - Country:US
Mailing Address - Phone:956-451-1673
Mailing Address - Fax:956-290-8382
Practice Address - Street 1:1101 VINE AVE STE A&B
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-4079
Practice Address - Country:US
Practice Address - Phone:956-451-1673
Practice Address - Fax:956-290-8382
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94488101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional