Provider Demographics
NPI:1720498165
Name:GARCIA, MYRA (LCSW-S)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LCSW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 E YANDELL DR STE 231
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-3724
Mailing Address - Country:US
Mailing Address - Phone:915-247-2407
Mailing Address - Fax:
Practice Address - Street 1:2601 E YANDELL DR STE 231
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-3724
Practice Address - Country:US
Practice Address - Phone:915-247-2407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090279104100000X
TX649971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker