Provider Demographics
NPI:1891100616
Name:BAZOR, JOSSELYN KELLIE (LBSW)
Entity Type:Individual
Prefix:
First Name:JOSSELYN
Middle Name:KELLIE
Last Name:BAZOR
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 COMMERCE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-2184
Mailing Address - Country:US
Mailing Address - Phone:512-248-7608
Mailing Address - Fax:
Practice Address - Street 1:211 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-2184
Practice Address - Country:US
Practice Address - Phone:512-248-7608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58040171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator