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General NPI Number Information
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NPI Number | 1962720276
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Entity Type | Individual
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Provider Name | JESSE C GARZA JR. MA, LMHC, LPC
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Gender | Male
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Dates
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Enumeration Date | 05/11/2010
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Last Update Date | 12/22/2011
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Provider Practice Location Address
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Address Line | 6500 N MILITARY TRL UNIT 524
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-1274
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Country | US
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Telephone | 334-412-4581
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Fax |
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Provider Business Mailing Address
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Address Line | 6500 N MILITARY TRL UNIT 524
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-1274
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Country | US
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Telephone | 334-412-4581
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2696
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH-8808
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License Number State | FL
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