Provider Demographics
NPI:1316331853
Name:GARZA, HANNA M (MS, LPC)
Entity type:Individual
Prefix:
First Name:HANNA
Middle Name:M
Last Name:GARZA
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:HANNA
Other - Middle Name:MYKOLAYIVNA
Other - Last Name:PONOMARENKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:3100 ELK PT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-2778
Mailing Address - Country:US
Mailing Address - Phone:915-877-0444
Mailing Address - Fax:915-581-7980
Practice Address - Street 1:2100 HOWZE ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-1526
Practice Address - Country:US
Practice Address - Phone:915-877-0444
Practice Address - Fax:915-581-7980
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-23
Last Update Date:2019-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NMT0172411101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX391983901Medicaid
NM64153274Medicaid