MEDICARE: ELIZABETH LEWIS MEZGER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1639899909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH LEWIS MEZGER

Provider Business Mailing Address
First Line	:	3810 ROSIN CT STE 170
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-1658
Country	:	US
Telephone Number	:	916-567-4222
Fax Number	:	916-567-4220

Provider Business Practice Location Address
First Line	:	2335 AMERICAN RIVER DR STE 301
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-7088
Country	:	US
Telephone Number	:	925-623-3301
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2022
Last Update Date	:	05/31/2023

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