Provider Demographics
NPI:1750750634
Name:KELLIE GARZA LLC
Entity type:Organization
Organization Name:KELLIE GARZA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, CST
Authorized Official - Phone:321-403-7036
Mailing Address - Street 1:5445 VILLAGE DR STE 104
Mailing Address - Street 2:
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32955-6666
Mailing Address - Country:US
Mailing Address - Phone:321-403-7036
Mailing Address - Fax:
Practice Address - Street 1:5445 VILLAGE DR STE 104
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32955-6666
Practice Address - Country:US
Practice Address - Phone:321-403-7036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9492101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty