Provider Demographics
NPI:1225626898
Name:CHARLES-MEZIL, SUZY
Entity Type:Individual
Prefix:
First Name:SUZY
Middle Name:
Last Name:CHARLES-MEZIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8010 NE 110TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64157-8172
Mailing Address - Country:US
Mailing Address - Phone:816-585-8785
Mailing Address - Fax:
Practice Address - Street 1:2600 E 12TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64127-1321
Practice Address - Country:US
Practice Address - Phone:816-965-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020041273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS11967OtherMY LMSW KANSAS NO.
MO2020041273OtherMY LMSW LICENSE NO.