Provider Demographics
NPI:1518626266
Name:AZADUI, CIBELLE
Entity type:Individual
Prefix:
First Name:CIBELLE
Middle Name:
Last Name:AZADUI
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 1:14205 N MO PAC EXPY
Mailing Address - Street 2:STE 570 PMB 113548
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728
Mailing Address - Country:US
Mailing Address - Phone:512-270-0711
Mailing Address - Fax:
Practice Address - Street 1:1423 BROADWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2054
Practice Address - Country:US
Practice Address - Phone:510-838-1206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205130106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist