Provider Demographics
NPI:1477336394
Name:MIZE, ISABEL TERESA (MFT)
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:TERESA
Last Name:MIZE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MISS
Other - First Name:ISABEL
Other - Middle Name:TERESA
Other - Last Name:MIZE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:25 WREDEN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1618
Mailing Address - Country:US
Mailing Address - Phone:415-302-2602
Mailing Address - Fax:
Practice Address - Street 1:25 WREDEN AVE
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:CA
Practice Address - Zip Code:94930-1618
Practice Address - Country:US
Practice Address - Phone:415-302-2602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health