Organization
GARCIA CLINICAL PSYCHOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN GARCIA PH.D. (OWNER)
(801) 410-0888
Entity
Organization
Contact information
Practice address
1060 E 100 S, SUITE 100, SALT LAKE CITY, UT 84102-1501
(801) 410-0888
Mailing address
1060 E 100 S, SUITE 100, SALT LAKE CITY, UT 84102-1501
(801) 410-0888
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
2013-03569
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000073660
MEDICARE
UT
Enumeration date
12/09/2013
Last updated
12/09/2013
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