Provider Demographics
NPI:1033469929
Name:JOHN, SIJI LIZZA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SIJI
Middle Name:LIZZA
Last Name:JOHN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 GREEN OAK PL
Mailing Address - Street 2:SUITE 250
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2057
Mailing Address - Country:US
Mailing Address - Phone:281-657-6052
Mailing Address - Fax:281-657-6052
Practice Address - Street 1:1521 GREEN OAK PL
Practice Address - Street 2:SUITE 250
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2057
Practice Address - Country:US
Practice Address - Phone:281-657-6052
Practice Address - Fax:281-657-6052
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35052103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical