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General NPI Number Information
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NPI Number | 1023828779
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Entity Type | Individual
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Provider Name | GAVIN GARCIA
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Gender | Male
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 2202 S 11TH ST
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City | LINCOLN
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State | NE
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Zip | 68502-3559
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Country | US
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Telephone | 402-475-8748
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Fax |
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Provider Business Mailing Address
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Address Line | 2633 P ST
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City | LINCOLN
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State | NE
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Zip | 68503-3528
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Country | US
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Telephone | 402-475-8748
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 14196
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License Number State |
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