Provider Demographics
NPI:1700138930
Name:GARCIA, JESSE (LMSW)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 E SELTICE WAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7082
Mailing Address - Country:US
Mailing Address - Phone:208-619-0190
Mailing Address - Fax:208-619-0195
Practice Address - Street 1:1417 N 4TH ST
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3310
Practice Address - Country:US
Practice Address - Phone:208-619-0190
Practice Address - Fax:208-619-0195
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW 32338104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker