Organization
GARZA THERAPEUTIC, LLC
Active
Other names
Garza Therapeutic,LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROY GARZA LICSW (CLININCAL DIRECTOR)
(651) 324-8341
Entity
Organization
Contact information
Practice address
33 E. WENTWROTH AVE., #292, WEST ST. PAUL, MN 55113
(651) 917-8698
(866) 879-4712
Mailing address
33 WENTWORTH AVE E, #292, WEST ST PAUL, MN 55118-3431
(651) 917-8698
(866) 879-4712
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
12842
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900002696
MEDICARE ID
MN
Enumeration date
12/21/2011
Last updated
03/06/2012
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