Provider Demographics
NPI:1093271934
Name:MIZZELL, JORDAN BLAIR (LPC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:BLAIR
Last Name:MIZZELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 MONTGOMERY HWY STE 202
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1839
Mailing Address - Country:US
Mailing Address - Phone:205-916-0123
Mailing Address - Fax:205-916-0878
Practice Address - Street 1:701 MONTGOMERY HWY STE 202
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-1839
Practice Address - Country:US
Practice Address - Phone:205-916-0123
Practice Address - Fax:205-916-0878
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3810101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor