Provider Demographics
NPI:1689555807
Name:NAZARIO, BIANCA
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:NAZARIO
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 1:2951 PICADILLY LN APT 712
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-2078
Mailing Address - Country:US
Mailing Address - Phone:214-494-9779
Mailing Address - Fax:
Practice Address - Street 1:161 SUMMIT AVE STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7072
Practice Address - Country:US
Practice Address - Phone:214-494-9779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health