Healthcare Provider Details

I. General information

NPI: 1265337257
Provider Name (Legal Business Name): STARGLADE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4006 SAINT PETER ST UNIT A
SALADO TX
76571-2141
US

IV. Provider business mailing address

2112 SW H K DODGEN LOOP STE 183 PMB 1044
TEMPLE TX
76504
US

V. Phone/Fax

Practice location:
  • Phone: 512-763-2966
  • Fax:
Mailing address:
  • Phone: 512-763-2966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: AURICA GARZA
Title or Position: MANAGING MEMBER
Credential: LPC
Phone: 512-763-2966