Provider Demographics
NPI:1104439082
Name:DAZONA LIFE AND LEARNING CENTER
Entity type:Organization
Organization Name:DAZONA LIFE AND LEARNING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MABRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LPC
Authorized Official - Phone:254-519-1144
Mailing Address - Street 1:14140 HWY 195
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-4850
Mailing Address - Country:US
Mailing Address - Phone:254-516-1144
Mailing Address - Fax:254-519-1155
Practice Address - Street 1:14140 HWY 195
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-4850
Practice Address - Country:US
Practice Address - Phone:254-516-1144
Practice Address - Fax:254-519-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services