MEDICARE: MR. RUBEN J 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	101Y00000X	Counselor	11289	TX
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	11289	TX

General Provider Information

NPI Number	:	1609174630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RUBEN J GARCIA LCDC

Provider Business Mailing Address
First Line	:	PO BOX 27512
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78755-2512
Country	:	US
Telephone Number	:	512-589-6886
Fax Number	:

Provider Business Practice Location Address
First Line	:	4807 SPICEWOOD SPRINGS RD
Second Line	:	BLDG. 2, SUITE 103
City	:	AUSTIN
State	:	TX
Zip	:	78759-8444
Country	:	US
Telephone Number	:	512-589-6886
Fax Number	:

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

Provider Enumeration Date	:	02/28/2011
Last Update Date	:	08/28/2013

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