Provider Demographics
NPI:1144318247
Name:GARCIA, MARIO BELTRAN (LCSW)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:BELTRAN
Last Name:GARCIA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4755 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2449
Mailing Address - Country:US
Mailing Address - Phone:520-458-3932
Mailing Address - Fax:520-803-7512
Practice Address - Street 1:4341 S HIGHWAY 92
Practice Address - Street 2:SUITE F
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85650-9399
Practice Address - Country:US
Practice Address - Phone:520-803-7500
Practice Address - Fax:520-803-7512
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSW-05541101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0913160OtherBCBS
AZ988909OtherAHCCCS