Provider Demographics
NPI:1720753841
Name:PAZ, JENNIFER (LSSP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PAZ
Suffix:
Gender:F
Credentials:LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15009 NUTTALL DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78724-6391
Mailing Address - Country:US
Mailing Address - Phone:512-716-9666
Mailing Address - Fax:
Practice Address - Street 1:15009 NUTTALL DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78724-6391
Practice Address - Country:US
Practice Address - Phone:512-716-9666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71037103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool