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General NPI Number Information
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NPI Number | 1114251493
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Entity Type | Organization
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Legal Business Name | DR. SHIRIN M. BAZAZ, LLC
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Dates
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Enumeration Date | 09/20/2009
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Last Update Date | 09/20/2009
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Provider Practice Location Address
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Address Line | 1600 W 38TH ST SUITE 420
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City | AUSTIN
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State | TX
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Zip | 78731-6400
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Country | US
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Telephone | 512-636-1704
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Fax | 512-374-4901
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Provider Business Mailing Address
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Address Line | 1600 W 38TH ST SUITE 420
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City | AUSTIN
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State | TX
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Zip | 78731-6400
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Country | US
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Telephone | 512-636-1704
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Fax | 512-374-4901
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHIRIN M BAZAZ
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Credential | PSY.D.
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Telephone | 512-636-1704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 33557
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License Number State | TX
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