Healthcare Provider Details

I. General information

NPI: 1073219762
Provider Name (Legal Business Name): BEVERLY MIZRANY LPC ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 02/03/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12715 TELGE RD
CYPRESS TX
77429-2289
US

IV. Provider business mailing address

12715 TELGE RD
CYPRESS TX
77429-2289
US

V. Phone/Fax

Practice location:
  • Phone: 713-466-1360
  • Fax:
Mailing address:
  • Phone: 713-466-1360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number87848
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: