Provider Demographics
NPI:1801652334
Name:HEPHZIBAH, ISAIAH
Entity type:Individual
Prefix:
First Name:ISAIAH
Middle Name:
Last Name:HEPHZIBAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5704 SPRING VALLEY RD APT 2038
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-3211
Mailing Address - Country:US
Mailing Address - Phone:214-436-1595
Mailing Address - Fax:
Practice Address - Street 1:5704 SPRING VALLEY RD APT 2038
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-3211
Practice Address - Country:US
Practice Address - Phone:214-436-1595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician