Provider Demographics
NPI:1114366267
Name:MIZORI, SHELAN GHAZI (MSW)
Entity Type:Individual
Prefix:MS
First Name:SHELAN
Middle Name:GHAZI
Last Name:MIZORI
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 S TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0046
Mailing Address - Country:US
Mailing Address - Phone:248-456-8150
Mailing Address - Fax:
Practice Address - Street 1:1063 PROFESSIONAL DR
Practice Address - Street 2:D-4
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3636
Practice Address - Country:US
Practice Address - Phone:810-496-4937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010914841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical