Provider Demographics
NPI:1487477204
Name:GARCIA, VANESSA ISABEL (LPC)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ISABEL
Last Name:GARCIA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 EAST ST LOT 52
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-5291
Mailing Address - Country:US
Mailing Address - Phone:620-803-2375
Mailing Address - Fax:
Practice Address - Street 1:1119 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2920
Practice Address - Country:US
Practice Address - Phone:620-803-2375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03998101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty