Healthcare Provider Details

I. General information

NPI: 1649603895
Provider Name (Legal Business Name): TANDI JEAN MIZE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANDI JEAN FINCHER

II. Dates (important events)

Enumeration Date: 08/12/2013
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W FEDERAL ST
SHAWNEE OK
74804-3626
US

IV. Provider business mailing address

20 SENECA DR
SHAWNEE OK
74801-5571
US

V. Phone/Fax

Practice location:
  • Phone: 405-640-7954
  • Fax:
Mailing address:
  • Phone: 405-640-7954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5268
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5628
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: