Provider Demographics
NPI:1205400173
Name:GARZA, LISA MARIE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:GARZA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3553 EVY LN
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-8356
Mailing Address - Country:US
Mailing Address - Phone:575-621-6945
Mailing Address - Fax:575-449-4157
Practice Address - Street 1:3553 EVY LN
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-8356
Practice Address - Country:US
Practice Address - Phone:575-621-6945
Practice Address - Fax:575-449-4157
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-16
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-116981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty