Healthcare Provider Details

I. General information

NPI: 1013102797
Provider Name (Legal Business Name): JUAN MANUEL GARCIA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1539 W GARVEY AVE N
WEST COVINA CA
91790-2139
US

IV. Provider business mailing address

22741 IRONBARK DR
DIAMOND BAR CA
91765-2519
US

V. Phone/Fax

Practice location:
  • Phone: 626-960-4844
  • Fax:
Mailing address:
  • Phone: 626-277-5327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW85999
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW22982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: