Healthcare Provider Details

I. General information

NPI: 1154072064
Provider Name (Legal Business Name): MARIO ANTONIO GARCIA LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14722 S NAPERVILLE RD STE 100
PLAINFIELD IL
60544-3308
US

IV. Provider business mailing address

14722 S NAPERVILLE RD STE 100
PLAINFIELD IL
60544-3308
US

V. Phone/Fax

Practice location:
  • Phone: 815-255-0205
  • Fax:
Mailing address:
  • Phone: 779-456-5635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.016322
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.018131
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: