Healthcare Provider Details

I. General information

NPI: 1295036515
Provider Name (Legal Business Name): REBECCA ADELE MIZHIR MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 CASS ST
PORT TOWNSEND WA
98368-8111
US

IV. Provider business mailing address

430 CASS ST
PORT TOWNSEND WA
98368-8111
US

V. Phone/Fax

Practice location:
  • Phone: 360-301-2558
  • Fax: 360-379-2754
Mailing address:
  • Phone: 360-301-2558
  • Fax: 360-379-2754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF60171923
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: