Provider Demographics
NPI:1366733214
Name:MIRABAL GARCIA, MADEL
Entity type:Individual
Prefix:
First Name:MADEL
Middle Name:
Last Name:MIRABAL GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 GARDEN CANYON DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-4249
Mailing Address - Country:US
Mailing Address - Phone:702-684-2143
Mailing Address - Fax:
Practice Address - Street 1:8118 FRY RD STE 204
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-7851
Practice Address - Country:US
Practice Address - Phone:979-459-8122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109749101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health