Provider Demographics
NPI:1295036515
Name:MIZHIR, REBECCA ADELE (MFT)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ADELE
Last Name:MIZHIR
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 CASS ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-8111
Mailing Address - Country:US
Mailing Address - Phone:360-301-2558
Mailing Address - Fax:360-379-2754
Practice Address - Street 1:430 CASS ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-8111
Practice Address - Country:US
Practice Address - Phone:360-301-2558
Practice Address - Fax:360-379-2754
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60171923106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist