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General NPI Number Information
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NPI Number | 1841637063
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Entity Type | Individual
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Provider Name | KISHA NICOLE BAZELAIS PHD
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Gender | Female
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Dates
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Enumeration Date | 05/29/2013
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 7901 4TH ST N # 8939
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City | ST PETERSBURG
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State | FL
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Zip | 33702-4305
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Country | US
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Telephone | 305-676-7347
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Fax |
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Provider Business Mailing Address
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Address Line | 9621 W ELM LN
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City | MIRAMAR
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State | FL
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Zip | 33025-2328
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Country | US
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Telephone | 347-743-4392
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 020128
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number | 020128
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PY9272
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License Number State | FL
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