Organization
BIZBAN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURIE A BIZZELL PHD (PSYCHOLOGIST)
(210) 643-4393
Entity
Organization
Contact information
Practice address
1162 E SONTERRA BLVD, SUITE 130, SAN ANTONIO, TX 78258-4047
(210) 643-4393
(210) 408-1096
Mailing address
1162 E SONTERRA BLVD, SUITE 130, SAN ANTONIO, TX 78258-4047
(210) 643-4393
(210) 408-1096
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
30855
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30855
LICENSE NUMBER
TX
Enumeration date
07/08/2015
Last updated
07/08/2015
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