Provider Demographics
NPI:1730555301
Name:GARCIA, KELSEY BROOKE
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:BROOKE
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3715 W BARSTOW AVE APT 213
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-6667
Mailing Address - Country:US
Mailing Address - Phone:559-367-1708
Mailing Address - Fax:
Practice Address - Street 1:1040 E HERNDON AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3158
Practice Address - Country:US
Practice Address - Phone:559-422-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health