MEDICARE: NINA GARCIA RDT, LPC INTERN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	82823	TX
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1245703701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINA GARCIA RDT, LPC INTERN

Provider Business Mailing Address
First Line	:	3107 ST EMANUEL ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-1346
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5100 WESTHEIMER RD STE 258
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-5512
Country	:	US
Telephone Number	:	281-713-5165
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2019
Last Update Date	:	10/04/2019

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