Provider Demographics
NPI:1801495486
Name:GARCIA, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GARCIA
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 1:1601 S MOPAC EXPY STE C300
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7077
Mailing Address - Country:US
Mailing Address - Phone:512-920-1030
Mailing Address - Fax:512-256-1983
Practice Address - Street 1:5700 S MOPAC EXPY STE 310
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1457
Practice Address - Country:US
Practice Address - Phone:512-458-0260
Practice Address - Fax:512-532-6160
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-18-50076106S00000X
CA1-22-62685103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician