Healthcare Provider Details

I. General information

NPI: 1174985238
Provider Name (Legal Business Name): BOBBY KIZER PHD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2016
Last Update Date: 03/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6851 MEMPHIS ST
NEW ORLEANS LA
70124-3341
US

IV. Provider business mailing address

6851 MEMPHIS ST
NEW ORLEANS LA
70124-3341
US

V. Phone/Fax

Practice location:
  • Phone: 504-899-6873
  • Fax:
Mailing address:
  • Phone: 504-899-6873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1206
License Number StateLA

VIII. Authorized Official

Name: ROBERT KIZER
Title or Position: LICENSED PSYCHOLOGIST / OWNER
Credential: PHD
Phone: 504-390-5782