=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053138669
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DORIS IZUWAH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2024
-----------------------------------------------------
Last Update Date | 02/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8118 FRY RD STE 701
-----------------------------------------------------
City | CYPRESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77433-7850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-815-5033
-----------------------------------------------------
Fax | 281-815-8537
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4936 STEEPLE CHASE CT
-----------------------------------------------------
City | GRAND PRAIRIE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75052-4598
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 945-244-3906
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | 8025
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------