Healthcare Provider Details

I. General information

NPI: 1437873627
Provider Name (Legal Business Name): MARIAH GARCIA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIAH JOHNS GARCIA LMSW

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 E MAGIC VIEW DR STE 192
MERIDIAN ID
83642-6246
US

IV. Provider business mailing address

2950 E MAGIC VIEW DR STE 192
MERIDIAN ID
83642-6246
US

V. Phone/Fax

Practice location:
  • Phone: 208-600-2184
  • Fax:
Mailing address:
  • Phone: 208-600-2184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number42721
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: