Provider Demographics
NPI:1053037895
Name:GARCIA, TAIZ I
Entity type:Individual
Prefix:
First Name:TAIZ
Middle Name:I
Last Name: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 1:1750 N WASHINGTON ST STE 120
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1335
Mailing Address - Country:US
Mailing Address - Phone:630-315-0021
Mailing Address - Fax:
Practice Address - Street 1:1750 N WASHINGTON ST STE 120
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1335
Practice Address - Country:US
Practice Address - Phone:630-315-0021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.018441101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional