Healthcare Provider Details

I. General information

NPI: 1922152297
Provider Name (Legal Business Name): MICHAEL JAMES MIZE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 NASA PKWY # 315
HOUSTON TX
77058-3310
US

IV. Provider business mailing address

1504 7TH ST
LEAGUE CITY TX
77573-2544
US

V. Phone/Fax

Practice location:
  • Phone: 281-333-3633
  • Fax: 281-333-4123
Mailing address:
  • Phone: 281-554-6919
  • Fax: 281-316-0343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1683
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: