Provider Demographics
NPI:1619715117
Name:GALARZA, JACQUELINE RAQUEL (LPC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:RAQUEL
Last Name:GALARZA
Suffix:
Gender:F
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:PO BOX 732
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-0732
Mailing Address - Country:US
Mailing Address - Phone:830-637-7848
Mailing Address - Fax:
Practice Address - Street 1:3340 SH 71 W
Practice Address - Street 2:
Practice Address - City:HORSESHOE BAY
Practice Address - State:TX
Practice Address - Zip Code:78657-9657
Practice Address - Country:US
Practice Address - Phone:830-637-7848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89270101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional