Healthcare Provider Details

I. General information

NPI: 1114901683
Provider Name (Legal Business Name): CATHERINE PATRICIA GARCIA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 01/24/2006
Reactivation Date: 03/05/2007

III. Provider practice location address

1140 WADE CIRCLE NE
ALBUQUERQUE NM
87112
US

IV. Provider business mailing address

1140 WADE CIRCLE NE
ALBUQUERQUE NM
87112
US

V. Phone/Fax

Practice location:
  • Phone: 505-934-1712
  • Fax:
Mailing address:
  • Phone: 505-934-1712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0086431
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: