Provider Demographics
NPI:1851271639
Name:GARCIA, BRYAN EDWARD (LPCC)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:EDWARD
Last Name:GARCIA
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6438 RIVERDALE DR NW
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:MN
Mailing Address - Zip Code:55303-4809
Mailing Address - Country:US
Mailing Address - Phone:651-755-4276
Mailing Address - Fax:888-972-5307
Practice Address - Street 1:6230 10TH ST N STE 220
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-6160
Practice Address - Country:US
Practice Address - Phone:651-755-4276
Practice Address - Fax:888-972-5307
Is Sole Proprietor?:No
Enumeration Date:2025-09-03
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5172101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1174955397Medicaid