Provider Demographics
NPI:1316922537
Name:OZBEK, IRENE NICHOLS (PHD)
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:NICHOLS
Last Name:OZBEK
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 1:6216 AIRPARK DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2988
Mailing Address - Country:US
Mailing Address - Phone:423-899-0024
Mailing Address - Fax:423-899-5688
Practice Address - Street 1:6216 AIRPARK DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2988
Practice Address - Country:US
Practice Address - Phone:423-899-0024
Practice Address - Fax:423-899-5688
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
P 657103T00000X
GAPSY001957103TC0700X
TNP657103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3157018OtherBLUE CROSS BLUE SHIELD
TN3689825Medicare UPIN
3689824Medicare ID - Type Unspecified