Provider Demographics
NPI:1740681121
Name:BIZZELL, LAURIE (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
Last Name:BIZZELL
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 1:1162 E SONTERRA BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4047
Mailing Address - Country:US
Mailing Address - Phone:210-538-1970
Mailing Address - Fax:
Practice Address - Street 1:1162 E SONTERRA BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4047
Practice Address - Country:US
Practice Address - Phone:210-538-1970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30855103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical