Healthcare Provider Details

I. General information

NPI: 1508292012
Provider Name (Legal Business Name): STEVIE GONZALES MIZZI M.S., L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 LA MAISON RD
DUSON LA
70529-3601
US

IV. Provider business mailing address

620 LA MAISON RD
DUSON LA
70529-3601
US

V. Phone/Fax

Practice location:
  • Phone: 337-212-1360
  • Fax:
Mailing address:
  • Phone: 337-212-1360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4998
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: