MEDICARE: JENNIFER RENAE GARZA MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	69855	TX

General Provider Information

NPI Number	:	1417340670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER RENAE GARZA MA, LPC

Provider Business Mailing Address
First Line	:	3407 FOREST FROST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-3056
Country	:	US
Telephone Number	:	210-677-2820
Fax Number	:

Provider Business Practice Location Address
First Line	:	3407 FOREST FROST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-3056
Country	:	US
Telephone Number	:	210-677-2820
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2015
Last Update Date	:	01/19/2016

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