MEDICARE: JENNIFER A BAZAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	19844	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336196641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER A BAZAN

Provider Business Mailing Address
First Line	:	5104 MARTIN AVE
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78751-2119
Country	:	US
Telephone Number	:	469-323-7962
Fax Number	:

Provider Business Practice Location Address
First Line	:	8400 N MOPAC EXPY
Second Line	:	SUITE 302
City	:	AUSTIN
State	:	TX
Zip	:	78759-8328
Country	:	US
Telephone Number	:	512-213-2388
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	12/01/2011

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Directions to “ JENNIFER A BAZAN ” Practice Location

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