Provider Demographics
NPI:1215458997
Name:GARCIA-CUELLAR, JOSE DE JESUS (LCSW)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:DE JESUS
Last Name:GARCIA-CUELLAR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:DE JESUS
Other - Last Name:GARCIA-CUELLAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-S
Mailing Address - Street 1:7701 N LAMAR BLVD STE 313
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-1080
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7701 N LAMAR BLVD STE 313
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752
Practice Address - Country:US
Practice Address - Phone:512-766-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2019-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX599531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical