Healthcare Provider Details

I. General information

NPI: 1700791605
Provider Name (Legal Business Name): RAYMOND L. MIZER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 REDONDO LN
PUEBLO CO
81005-2953
US

IV. Provider business mailing address

4 REDONDO LN
PUEBLO CO
81005-2953
US

V. Phone/Fax

Practice location:
  • Phone: 719-744-7444
  • Fax: 719-744-7444
Mailing address:
  • Phone: 719-744-7444
  • Fax: 719-744-7444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYMOND L. MIZER
Title or Position: MENTAL HEALTH THERAPIST.
Credential: LPC
Phone: 719-744-7444