Provider Demographics
NPI:1205418761
Name:GARZA, LORI ANN (RBT)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:GARZA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 TENDERFOOT TRL
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-2333
Mailing Address - Country:US
Mailing Address - Phone:803-703-9750
Mailing Address - Fax:
Practice Address - Street 1:119 TENDERFOOT TRL
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-2333
Practice Address - Country:US
Practice Address - Phone:830-703-9750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-24
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BACB499196106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician