Garza Therapeutic, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

12842 Issued in MN

Legal business name

GARZA THERAPEUTIC, LLC

Practice address

33 E. Wentwroth Ave.
#292
West St. Paul, MN 55113

Phone

(651) 917-8698

Fax

(866) 879-4712

NPI assigned

Dec 21, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Roy Garza, LICSW

Title

Clinincal Director

Phone

(651) 324-8341

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Garza Therapeutic,LLC Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1324425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330992000000",
    "number": "1205105103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 WENTWORTH AVE E",
            "address_2": "#292",
            "city": "WEST ST PAUL",
            "state": "MN",
            "postal_code": "551183431",
            "telephone_number": "651-917-8698",
            "fax_number": "866-879-4712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 E. WENTWROTH AVE.",
            "address_2": "#292",
            "city": "WEST ST. PAUL",
            "state": "MN",
            "postal_code": "55113",
            "telephone_number": "651-917-8698",
            "fax_number": "866-879-4712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARZA THERAPEUTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-21",
        "last_updated": "2012-03-06",
        "status": "A",
        "authorized_official_last_name": "GARZA",
        "authorized_official_first_name": "ROY",
        "authorized_official_title_or_position": "CLININCAL DIRECTOR",
        "authorized_official_telephone_number": "651-324-8341",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MN",
            "license": "12842",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "900002696",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Garza Therapeutic,LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Providers in West St. Paul, MN by specialty
• Community/Behavioral Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.