Provider Demographics
NPI:1962720276
Name:GARZA, JESSE C JR (MA, LMHC, LPC)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:C
Last Name:GARZA
Suffix:JR
Gender:M
Credentials:MA, LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 N MILITARY TRL UNIT 524
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-1274
Mailing Address - Country:US
Mailing Address - Phone:334-412-4581
Mailing Address - Fax:
Practice Address - Street 1:6500 N MILITARY TRL UNIT 524
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-1274
Practice Address - Country:US
Practice Address - Phone:334-412-4581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2696101YP2500X
FLMH-8808101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional