Healthcare Provider Details

I. General information

NPI: 1154889947
Provider Name (Legal Business Name): LAURA MIZELL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 BLUE PWKY
KANSAS CITY MO
64130
US

IV. Provider business mailing address

1108 E 30TH ST APT 215
KANSAS CITY MO
64109-1517
US

V. Phone/Fax

Practice location:
  • Phone: 816-599-5533
  • Fax:
Mailing address:
  • Phone: 540-735-6039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: