Healthcare Provider Details

I. General information

NPI: 1770124992
Provider Name (Legal Business Name): JANA ANN MIZE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S CHERRY ST
HARRISON AR
72601-5024
US

IV. Provider business mailing address

110 S CHERRY ST
HARRISON AR
72601-5024
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-0581
  • Fax: 870-741-8883
Mailing address:
  • Phone: 870-741-0581
  • Fax: 870-741-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9793-M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: