Healthcare Provider Details

I. General information

NPI: 1912489121
Provider Name (Legal Business Name): MORGAN MIZELL MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28631 S WESTERN AVE
RANCHO PALOS VERDES CA
90275-0816
US

IV. Provider business mailing address

1265 W 13TH ST
SAN PEDRO CA
90731-3803
US

V. Phone/Fax

Practice location:
  • Phone: 310-999-1410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT105642
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: