Provider Demographics
NPI:1134967516
Name:GARZA, LISA GENEVIEVE (MA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:GENEVIEVE
Last Name:GARZA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:G
Other - Last Name:TIRION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2416 ALLRED DR APT B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-1483
Mailing Address - Country:US
Mailing Address - Phone:512-663-4014
Mailing Address - Fax:
Practice Address - Street 1:5926 BALCONES DR STE 218
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4290
Practice Address - Country:US
Practice Address - Phone:512-651-5598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95477101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health