Provider Demographics
NPI:1104995844
Name:ZAK, ELIZABETH NOEL (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:NOEL
Last Name:ZAK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 TEASLEY LN
Mailing Address - Street 2:STE 303
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-8302
Mailing Address - Country:US
Mailing Address - Phone:940-383-8282
Mailing Address - Fax:940-565-8170
Practice Address - Street 1:3201 TEASLEY LN
Practice Address - Street 2:STE 303
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-8302
Practice Address - Country:US
Practice Address - Phone:940-383-8282
Practice Address - Fax:940-565-8170
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32399103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00178375OtherMEDICARE RAILROAD
TX86993AOtherBCBS
TX8F4296Medicare PIN
TX86993AOtherBCBS
TX8C7911Medicare ID - Type UnspecifiedDALLAS
TXP00178375Medicare ID - Type UnspecifiedRAILROAD
TX8C7912Medicare ID - Type UnspecifiedDENTON