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General NPI Number Information
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NPI Number | 1164853651
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Entity Type | Organization
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Legal Business Name | GARCIA CLINICAL PSYCHOLOGY, LLC
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 12/09/2013
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Provider Practice Location Address
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Address Line | 1060 E 100 S SUITE 100
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-1501
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Country | US
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Telephone | 801-410-0888
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Fax |
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Provider Business Mailing Address
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Address Line | 1060 E 100 S SUITE 100
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City | SALT LAKE CITY
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State | UT
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Zip | 84102-1501
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Country | US
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Telephone | 801-410-0888
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RYAN GARCIA
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Credential | PH.D.
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Telephone | 801-410-0888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2013-03569
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License Number State | UT
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