MEDICARE: LAREDO PSYCHOLOGICAL AND COUNSELING SERVICES

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
2	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1790630010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAREDO PSYCHOLOGICAL AND COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	2445 MONARCH DR UNIT 1303
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78045-6438
Country	:	US
Telephone Number	:	323-710-4072
Fax Number	:

Provider Business Practice Location Address
First Line	:	6510 POLARIS DR STE 1
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78041-2054
Country	:	US
Telephone Number	:	956-431-0402
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	EDIZA GARCIA
Credential	:	PSY.D.
Telephone Number	:	323-710-4072

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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