Individual
JENNIFER A BAZAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8400 N MOPAC EXPY, SUITE 302, AUSTIN, TX 78759-8328
(512) 213-2388
Mailing address
5104 MARTIN AVE, AUSTIN, TX 78751-2119
(469) 323-7962
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
19844
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
176552101
—
TX
Enumeration date
05/30/2006
Last updated
12/01/2011
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