Provider Demographics
NPI:1508292012
Name:MIZZI, STEVIE GONZALES (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:STEVIE
Middle Name:GONZALES
Last Name:MIZZI
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 LA MAISON RD
Mailing Address - Street 2:
Mailing Address - City:DUSON
Mailing Address - State:LA
Mailing Address - Zip Code:70529-3601
Mailing Address - Country:US
Mailing Address - Phone:337-212-1360
Mailing Address - Fax:
Practice Address - Street 1:620 LA MAISON RD
Practice Address - Street 2:
Practice Address - City:DUSON
Practice Address - State:LA
Practice Address - Zip Code:70529-3601
Practice Address - Country:US
Practice Address - Phone:337-212-1360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4998101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health