Provider Demographics
NPI:1932582913
Name:BIZBAN LLC
Entity Type:Organization
Organization Name:BIZBAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BIZZELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:210-643-4393
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:210-643-4393
Mailing Address - Fax:210-408-1096
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:210-643-4393
Practice Address - Fax:210-408-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30855103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX30855OtherLICENSE NUMBER