MEDICARE: KRYSTINE GARCIA LPC

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	LPC23446	AZ

General Provider Information

NPI Number	:	1982357919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTINE GARCIA LPC

Provider Business Mailing Address
First Line	:	4138 W CARTER RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-6084
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4138 W CARTER RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-6084
Country	:	US
Telephone Number	:	480-430-1188
Fax Number	:

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

Provider Enumeration Date	:	01/31/2022
Last Update Date	:	11/01/2024

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