Provider Demographics
NPI:1588679310
Name:BAZZIE, DENA MARIE (LPC LMFT)
Entity Type:Individual
Prefix:MS
First Name:DENA
Middle Name:MARIE
Last Name:BAZZIE
Suffix:
Gender:F
Credentials:LPC LMFT
Other - Prefix:
Other - First Name:DENA
Other - Middle Name:MAIRE
Other - Last Name:BAZZIE-JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2350 N KINGSWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605
Mailing Address - Country:US
Mailing Address - Phone:337-562-8100
Mailing Address - Fax:337-310-0614
Practice Address - Street 1:1204 W PRIEN LAKE RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601
Practice Address - Country:US
Practice Address - Phone:337-562-8100
Practice Address - Fax:337-310-0614
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2468101YP2500X
LA157106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist