Provider Demographics
NPI:1902919251
Name:GARCIA-WELCH, KIMBERLY A (MED, LPC, LSOTP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:GARCIA-WELCH
Suffix:
Gender:F
Credentials:MED, LPC, LSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 CALDERA BLVD APT 211
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-2862
Mailing Address - Country:US
Mailing Address - Phone:432-230-0849
Mailing Address - Fax:
Practice Address - Street 1:511 N ALLEGHANEY AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4405
Practice Address - Country:US
Practice Address - Phone:432-230-0849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99060101Y00000X
TX18501101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84814LOtherBCBS
TX124948OtherCHIPS/ TEXAS TRUE CHOICE