Provider Demographics
NPI:1750270294
Name:MIZE, BENJAMIN LARKIN
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LARKIN
Last Name:MIZE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BENJAMIN
Other - Middle Name:LARKIN MIZE
Other - Last Name:PATTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:549 MADISON POINT DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-4824
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 WIND HAVEN DR STE 202
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-8036
Practice Address - Country:US
Practice Address - Phone:859-230-8121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY299583106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist