Provider Demographics
NPI:1477521904
Name:GARZA, CEASAR (LPC)
Entity Type:Individual
Prefix:MR
First Name:CEASAR
Middle Name:
Last Name:GARZA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 MCCULLOUGH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3584
Mailing Address - Country:US
Mailing Address - Phone:210-736-1762
Mailing Address - Fax:210-736-3156
Practice Address - Street 1:2515 MCCULLOUGH AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3584
Practice Address - Country:US
Practice Address - Phone:210-736-1762
Practice Address - Fax:210-736-3156
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174358502101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174358502Medicaid