MEDICARE: MS. CRYSTAL M GARCIA LCDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	11256	TX

General Provider Information

NPI Number	:	1386910180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CRYSTAL M GARCIA LCDC

Provider Business Mailing Address
First Line	:	4022 GREEN MEADOW DR
Second Line	:	608
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-9750
Country	:	US
Telephone Number	:	325-315-3952
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 W BEAUREGARD AVE
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76901-3812
Country	:	US
Telephone Number	:	325-315-3952
Fax Number	:

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

Provider Enumeration Date	:	03/26/2012
Last Update Date	:	03/26/2012

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