Provider Demographics
NPI:1194456475
Name:GARZA, DANIEL VINCENT
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:VINCENT
Last Name:GARZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 COUNTRY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LA VERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121-4739
Mailing Address - Country:US
Mailing Address - Phone:210-392-9931
Mailing Address - Fax:
Practice Address - Street 1:1220 COUNTRY VIEW DR
Practice Address - Street 2:
Practice Address - City:LA VERNIA
Practice Address - State:TX
Practice Address - Zip Code:78121-4739
Practice Address - Country:US
Practice Address - Phone:210-392-9931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-18
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55364101YA0400X
TX84126101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)