Provider Demographics
NPI:1316721947
Name:GARZA, DELORES RAE
Entity type:Individual
Prefix:
First Name:DELORES
Middle Name:RAE
Last Name:GARZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7214 HIGHWAY 78 STE 3
Mailing Address - Street 2:
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-2502
Mailing Address - Country:US
Mailing Address - Phone:361-248-8653
Mailing Address - Fax:
Practice Address - Street 1:7214 HIGHWAY 78 STE 3
Practice Address - Street 2:
Practice Address - City:SACHSE
Practice Address - State:TX
Practice Address - Zip Code:75048-2502
Practice Address - Country:US
Practice Address - Phone:361-655-6684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86057101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty