Healthcare Provider Details

I. General information

NPI: 1720051386
Provider Name (Legal Business Name): JAMES SCOTT MIZES PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 HIGH ST SUITE 608
MORGANTOWN WV
26505-5429
US

IV. Provider business mailing address

44 MCKINLEY ST
MORGANTOWN WV
26501-4265
US

V. Phone/Fax

Practice location:
  • Phone: 304-413-4728
  • Fax: 304-581-3201
Mailing address:
  • Phone: 304-685-6062
  • Fax: 304-581-3201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number763
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: