Doctor Name: | DR. THERESA BARBARA BAZACOS |
NPI Number: | 1306103627 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | PY8481 |
Business Practice Address: | 5221 Bowersox Pkwy Firestone, CO - 805045904 |
Business Phone Number: | 5596180159 |
Business Fax Number: | |
Mailing Address: | 5221 Bowersox Pkwy, FIRESTONE |
State: | CO |
Postal Code: | 805045904 |
Phone Number: | 5596180159 |
Fax Number: | |
NPI Enumeration Date: | 04/12/2012 |
NPI Last Update Date: | 04/26/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PY8481 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |