Provider Demographics
NPI:1841754215
Name:KAZMO BRAIN CENTER LLC
Entity type:Organization
Organization Name:KAZMO BRAIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEZA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZEMI-MOHAMMADI
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:214-529-6953
Mailing Address - Street 1:4102 SUN KING LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4433 PUNJAB WAY STE 403
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-6746
Practice Address - Country:US
Practice Address - Phone:469-269-0080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty