Provider Demographics
NPI:1144893330
Name:GARCIA, JACOB C (BSW)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:C
Last Name:GARCIA
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
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Mailing Address - Street 1:3155 SNOW TRILLIUM WAY
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-9204
Mailing Address - Country:US
Mailing Address - Phone:720-295-3790
Mailing Address - Fax:877-400-4480
Practice Address - Street 1:3155 SNOW TRILLIUM WAY
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-9204
Practice Address - Country:US
Practice Address - Phone:720-295-3790
Practice Address - Fax:877-400-4480
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician