Provider Demographics
NPI:1588890438
Name:CENTER FOR BIOFEEDBACK AND BEHAVIOR THERAPY
Entity type:Organization
Organization Name:CENTER FOR BIOFEEDBACK AND BEHAVIOR THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSTY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOZANO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:469-358-1309
Mailing Address - Street 1:4530 BELTWAY DR
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3707
Mailing Address - Country:US
Mailing Address - Phone:469-358-1309
Mailing Address - Fax:
Practice Address - Street 1:4530 BELTWAY DR
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3707
Practice Address - Country:US
Practice Address - Phone:469-358-1309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60245101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty