Provider Demographics
NPI:1053138669
Name:IZUWAH, DORIS
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:IZUWAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4936 STEEPLE CHASE CT
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-4598
Mailing Address - Country:US
Mailing Address - Phone:945-244-3906
Mailing Address - Fax:
Practice Address - Street 1:8118 FRY RD STE 701
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-7850
Practice Address - Country:US
Practice Address - Phone:281-815-5033
Practice Address - Fax:281-815-8537
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TX8025103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician