Healthcare Provider Details

I. General information

NPI: 1255718474
Provider Name (Legal Business Name): LORENA MIZE MS, SUDP, LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 JOURNEY ST SE
OLYMPIA WA
98513-6779
US

IV. Provider business mailing address

510 TACOMA AVE S
TACOMA WA
98402-5416
US

V. Phone/Fax

Practice location:
  • Phone: 360-413-2727
  • Fax: 360-455-4620
Mailing address:
  • Phone: 253-572-4750
  • Fax: 253-272-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60341708
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61443400
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: