MEDICARE: NICK ZIZA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	E2615	OH

General Provider Information

NPI Number	:	1760548473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICK ZIZA

Provider Business Mailing Address
First Line	:	2600 FAR HILLS AVE
Second Line	:	SUITE 304
City	:	DAYTON
State	:	OH
Zip	:	45419-1687
Country	:	US
Telephone Number	:	937-296-0607
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 FAR HILLS AVE
Second Line	:	SUITE 304
City	:	DAYTON
State	:	OH
Zip	:	45419-1687
Country	:	US
Telephone Number	:	937-296-0607
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/08/2007

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