Provider Demographics
NPI:1497168348
Name:GARZA, GEORGINA MARIE (LPCC 5917)
Entity Type:Individual
Prefix:
First Name:GEORGINA
Middle Name:MARIE
Last Name:GARZA
Suffix:
Gender:F
Credentials:LPCC 5917
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3114 WILLOW AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-4750
Mailing Address - Country:US
Mailing Address - Phone:559-202-3564
Mailing Address - Fax:559-478-2047
Practice Address - Street 1:3114 WILLOW AVE STE 102
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-4750
Practice Address - Country:US
Practice Address - Phone:559-202-3564
Practice Address - Fax:559-478-2047
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health