Provider Demographics
NPI:1467175257
Name:MIZUSAWA, ALLIE MEISHA (LPC)
Entity Type:Individual
Prefix:
First Name:ALLIE
Middle Name:MEISHA
Last Name:MIZUSAWA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:MEISHA
Other - Last Name:MIZUSAWA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:2556 NEWARK CT UNIT 4210
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-1488
Mailing Address - Country:US
Mailing Address - Phone:505-400-0710
Mailing Address - Fax:
Practice Address - Street 1:1330 N LOGAN ST STE 201
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2309
Practice Address - Country:US
Practice Address - Phone:505-400-0710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC0017748101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty