Healthcare Provider Details

I. General information

NPI: 1629385869
Provider Name (Legal Business Name): LINDA MIZAK LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22214 D ST
WINFIELD KS
67156-7376
US

IV. Provider business mailing address

22214 D ST
WINFIELD KS
67156-7376
US

V. Phone/Fax

Practice location:
  • Phone: 620-442-4540
  • Fax:
Mailing address:
  • Phone: 620-442-4540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1147
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: