MEDICARE: MR. MICHAEL JAMES MIZE LPC

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	101YM0800X	Mental Health Counselor	1683	TX
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1922152297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL JAMES MIZE LPC

Provider Business Mailing Address
First Line	:	1504 7TH ST
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2544
Country	:	US
Telephone Number	:	281-554-6919
Fax Number	:	281-316-0343

Provider Business Practice Location Address
First Line	:	1110 NASA PKWY
Second Line	:	# 315
City	:	HOUSTON
State	:	TX
Zip	:	77058-3310
Country	:	US
Telephone Number	:	281-333-3633
Fax Number	:	281-333-4123

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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