Provider Demographics
NPI:1912478181
Name:GARCES, CARLO HOLGANZA
Entity Type:Individual
Prefix:
First Name:CARLO
Middle Name:HOLGANZA
Last Name:GARCES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 FREEMAN RD E STE 1
Mailing Address - Street 2:
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-3776
Mailing Address - Country:US
Mailing Address - Phone:253-922-7833
Mailing Address - Fax:253-922-7611
Practice Address - Street 1:2150 FREEMAN RD E STE 1
Practice Address - Street 2:
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-3776
Practice Address - Country:US
Practice Address - Phone:253-922-7833
Practice Address - Fax:253-922-7611
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60847601101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health