Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 33527 | TX |
NPI | 1063186542 |
---|---|
Provider Name | Benjamin R Garza |
First Address | Round Rock, TX 78664-7412 |
Second Address | Round Rock, TX 78664-7412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2021 |
Last Update Date | 06/08/2021 |