Provider Demographics
NPI:1285139873
Name:BAJZA, SUSAN ILONA (MA, PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ILONA
Last Name:BAJZA
Suffix:
Gender:F
Credentials:MA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27245 PAYNE CT
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-9055
Mailing Address - Country:US
Mailing Address - Phone:281-364-9685
Mailing Address - Fax:
Practice Address - Street 1:1610 WOODSTEAD CT STE 420
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3404
Practice Address - Country:US
Practice Address - Phone:281-363-4220
Practice Address - Fax:281-364-9404
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4858106H00000X
TX15679101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist