Provider Demographics
NPI:1891841235
Name:DE LA GARZA, GLORIA D (MA, LPC, NCC, RPT-S)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:D
Last Name:DE LA GARZA
Suffix:
Gender:F
Credentials:MA, LPC, NCC, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3534 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-6507
Mailing Address - Country:US
Mailing Address - Phone:210-365-2978
Mailing Address - Fax:
Practice Address - Street 1:3534 AVENUE B
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-6507
Practice Address - Country:US
Practice Address - Phone:210-365-2978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19061101Y00000X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX19061OtherLPC
TX67260OtherNCC
TX7023LCOtherBLUECROSS BLUESHIELD
TXS-942OtherRPT-S CERTIFICATE #