Provider Information for 1598107435
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JOHN LEE BAZAN LCSW
Sex: Male
NPI: 1598107435
Last Updated: 2017-03-14
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1598107435 | ||||||||
| Enumeration Date | 2013-07-19 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 4614 N IH 35 AUSTIN, TX 78751-3401 United States Phone: 512-978-9100 | Fax:512-901-9751 | ||||||||
| Primary Practice Address | 4614 N IH 35 AUSTIN, TX 78751-3401 United States Phone: 512-978-9100 | Fax:512-901-9751 | ||||||||
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