Provider Demographics
NPI:1750979704
Name:GARCIA, CARLOS ALFREDO JR (PLPC, NBCC)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ALFREDO
Last Name:GARCIA
Suffix:JR
Gender:M
Credentials:PLPC, NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 E ERIE ST APT A
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5240
Mailing Address - Country:US
Mailing Address - Phone:573-714-1405
Mailing Address - Fax:
Practice Address - Street 1:266 E ERIE ST APT A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5240
Practice Address - Country:US
Practice Address - Phone:573-714-1405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020042953101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional