Provider Demographics
NPI:1306964630
Name:GARZA, MAURILIO C (LMHC)
Entity type:Individual
Prefix:MR
First Name:MAURILIO
Middle Name:C
Last Name:GARZA
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6616
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-0628
Mailing Address - Country:US
Mailing Address - Phone:509-735-6616
Mailing Address - Fax:509-735-6181
Practice Address - Street 1:320 N JOHNSON ST
Practice Address - Street 2:SUITE 900
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2771
Practice Address - Country:US
Practice Address - Phone:509-735-6616
Practice Address - Fax:509-735-6181
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007522101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health