Basic Information
| Provider Information | |||||||||
| NPI: | 1750771911 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZISKIS | ||||||||
| FirstName: | ANGELA | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4749 WILLIAMS DR STE 301 | ||||||||
| Address2: | |||||||||
| City: | GEORGETOWN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786333711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128093141 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4110 GUALDALUPE STREET | ||||||||
| Address2: | BUILDING 794, SPECIALTY SERVICES | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129561995 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2015 | ||||||||
| LastUpdateDate: | 10/27/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 34886 | TX | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.