Provider Demographics
NPI:1629801493
Name:RIZVI, IMAAN BANO
Entity type:Individual
Prefix:
First Name:IMAAN
Middle Name:BANO
Last Name:RIZVI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 HILLCREST RD STE 150
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-5420
Mailing Address - Country:US
Mailing Address - Phone:972-429-5700
Mailing Address - Fax:
Practice Address - Street 1:4500 HILLCREST RD STE 150
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-5420
Practice Address - Country:US
Practice Address - Phone:972-429-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician