Healthcare Provider Details

I. General information

NPI: 1508580168
Provider Name (Legal Business Name): KAITLYN GARZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15455 CONWAY RD
CHESTERFIELD MO
63017-6022
US

IV. Provider business mailing address

2921 W ADAMS ST
SAINT CHARLES MO
63301-4603
US

V. Phone/Fax

Practice location:
  • Phone: 636-675-7566
  • Fax:
Mailing address:
  • Phone: 636-578-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: