Healthcare Provider Details

I. General information

NPI: 1588029136
Provider Name (Legal Business Name): MEGAN RAE GARZA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 08/23/2025
Certification Date: 08/23/2025
Deactivation Date: 05/17/2018
Reactivation Date: 08/28/2021

III. Provider practice location address

710 LANE 39
BURLINGTON WY
82411-9739
US

IV. Provider business mailing address

PO BOX 152
BURLINGTON WY
82411-0152
US

V. Phone/Fax

Practice location:
  • Phone: 623-688-7900
  • Fax:
Mailing address:
  • Phone: 623-688-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20673
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113936
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801118849
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1334
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: