Healthcare Provider Details

I. General information

NPI: 1902542095
Provider Name (Legal Business Name): AARON GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 OSUNA RD NE STE 102
ALBUQUERQUE NM
87109-2587
US

IV. Provider business mailing address

5801 OSUNA RD NE STE 102
ALBUQUERQUE NM
87109-2587
US

V. Phone/Fax

Practice location:
  • Phone: 505-639-4769
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCBT-2022-0083
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: