Basic Information
| Provider Information | |||||||||
| NPI: | 1134497720 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLELL | ||||||||
| FirstName: | ZAINAB | ||||||||
| MiddleName: | DENYS | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S., BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 E ROYAL LN | ||||||||
| Address2: | BLDG 3, STE 290 | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750393540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8558326727 | ||||||||
| FaxNumber: | 7726759100 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 E ROYAL LN | ||||||||
| Address2: | BLDG 3, STE 290 | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750393540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8558326727 | ||||||||
| FaxNumber: | 7726759100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2011 | ||||||||
| LastUpdateDate: | 07/24/2013 | ||||||||
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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 | 103K00000X | 1-11-9695 | TX | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 12329494 | 01 | TX | CAQH | OTHER | 0004BF | 01 | TX | BCBS PROVIDER NUMBER | OTHER | 9154794 | 01 | TX | AETNA PROVIDER NUMBER | OTHER |