Provider Demographics
NPI:1245348002
Name:KIZERIAN, GERALD D (PHD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:D
Last Name:KIZERIAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5866 S STAPLES ST
Mailing Address - Street 2:STE 320
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3785
Mailing Address - Country:US
Mailing Address - Phone:361-991-4101
Mailing Address - Fax:361-991-4102
Practice Address - Street 1:5866 S STAPLES ST
Practice Address - Street 2:STE 320
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3700
Practice Address - Country:US
Practice Address - Phone:361-991-4101
Practice Address - Fax:361-991-4102
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2968101YP2500X
TX002808106H00000X
TXS004831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095310101Medicaid
TX00S49JOtherBCBS PROVIDER NUMBER
TX8K8886Medicare PIN
TX00S49JOtherBCBS PROVIDER NUMBER
TX507558YMJMMedicare PIN