Healthcare Provider Details

I. General information

NPI: 1194493486
Provider Name (Legal Business Name): REYNA AMANDA GARCIA LPCC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 67133
ALBUQUERQUE NM
87193-7133
US

IV. Provider business mailing address

PO BOX 67133
ALBUQUERQUE NM
87193-7133
US

V. Phone/Fax

Practice location:
  • Phone: 505-289-3984
  • Fax:
Mailing address:
  • Phone: 505-289-3984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMH0221141
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-CTL0215641
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2024-0447
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: