Healthcare Provider Details

I. General information

NPI: 1447984497
Provider Name (Legal Business Name): LYMAN ALLAN MIZELL NBC-HWC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21074 FIRETOWER RD
LORANGER LA
70446-3654
US

IV. Provider business mailing address

21074 FIRETOWER RD
LORANGER LA
70446-3654
US

V. Phone/Fax

Practice location:
  • Phone: 985-474-9582
  • Fax:
Mailing address:
  • Phone: 985-474-9582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3632074
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: