Provider Demographics
NPI:1558916650
Name:MIZE, KAYELA LYNN (LLMSW)
Entity Type:Individual
Prefix:
First Name:KAYELA
Middle Name:LYNN
Last Name:MIZE
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:KAYELA
Other - Middle Name:LYNN
Other - Last Name:OBERLOIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 663
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48143-0663
Mailing Address - Country:US
Mailing Address - Phone:989-599-2129
Mailing Address - Fax:
Practice Address - Street 1:690 S TRUMBULL ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-7692
Practice Address - Country:US
Practice Address - Phone:989-992-5700
Practice Address - Fax:989-771-7050
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851107482104100000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No104100000XBehavioral Health & Social Service ProvidersSocial Worker