Provider Demographics
NPI:1760828628
Name:SHIBAZAKI, KOZUE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KOZUE
Middle Name:
Last Name:SHIBAZAKI
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 1:1823 CENTURY OAK TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4952
Mailing Address - Country:US
Mailing Address - Phone:210-200-9247
Mailing Address - Fax:210-493-6714
Practice Address - Street 1:11503 NW MILITARY HWY
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1884
Practice Address - Country:US
Practice Address - Phone:210-200-9247
Practice Address - Fax:210-493-6714
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31446103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling