Active NPI
Lisa Bazil, PHD
- Clinical Psychologist
- Dallas, TX
National Provider Identifier
1912262585
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 30531
- Practice address
- 12830 Hillcrest Rd
Suite D218
Dallas, TX 75230-1527 - Phone
- (817) 882-8880
- NPI assigned
- Jul 10, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 30531 | TX | Primary |
Addresses
Primary practice location
12830 Hillcrest Rd
Suite D218
Dallas, TX 75230-1527
Mailing address
PO Box 670787
Dallas, TX 75367-0787
Phone (817) 882-8880
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 5, 2024 through Feb 5, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30531 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1341878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402444800000",
"number": "1912262585",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 670787",
"city": "DALLAS",
"state": "TX",
"postal_code": "753670787",
"telephone_number": "817-882-8880"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12830 HILLCREST RD",
"address_2": "SUITE D218",
"city": "DALLAS",
"state": "TX",
"postal_code": "752301527",
"telephone_number": "817-882-8880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAZIL",
"first_name": "LISA",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-07-10",
"last_updated": "2014-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "30531",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.