Individual
DR. THERESA BARBARA BAZACOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
5221 BOWERSOX PKWY, FIRESTONE, CO 80504-5904
(559) 618-0159
Mailing address
5221 BOWERSOX PKWY, FIRESTONE, CO 80504-5904
(559) 618-0159
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY 3724
CO
103TC0700X
Clinical Psychologist
PY8481
FL
Other
Enumeration date
04/12/2012
Last updated
04/26/2012
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