Provider Demographics
NPI:1396578555
Name:GARZA-MEDRANO, CARLOS ALFREDO
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ALFREDO
Last Name:GARZA-MEDRANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 SCOTSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-2554
Mailing Address - Country:US
Mailing Address - Phone:469-579-9395
Mailing Address - Fax:
Practice Address - Street 1:9209 ELAM RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-4179
Practice Address - Country:US
Practice Address - Phone:469-780-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90013101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health