Provider Demographics
NPI:1215375266
Name:BEZAS, MICHAEL S (LPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:BEZAS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 CHENEY DR
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3472
Mailing Address - Country:US
Mailing Address - Phone:208-320-1108
Mailing Address - Fax:
Practice Address - Street 1:722 CHENEY DR
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3472
Practice Address - Country:US
Practice Address - Phone:208-320-1108
Practice Address - Fax:208-735-1890
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4680101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLPC-4680OtherLICENSED PROFESSIONAL COUNSELOR