Healthcare Provider Details

I. General information

NPI: 1144318247
Provider Name (Legal Business Name): MARIO BELTRAN GARCIA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4341 S HIGHWAY 92 SUITE F
SIERRA VISTA AZ
85650-9399
US

IV. Provider business mailing address

4755 CAMPUS DR
SIERRA VISTA AZ
85635-2449
US

V. Phone/Fax

Practice location:
  • Phone: 520-803-7500
  • Fax: 520-803-7512
Mailing address:
  • Phone: 520-458-3932
  • Fax: 520-803-7512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW-05541
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: