Provider Demographics
NPI:1255718474
Name:MIZE, LORENA (MS, SUDP, LMHCA)
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:MIZE
Suffix:
Gender:F
Credentials:MS, SUDP, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 TACOMA AVE S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-5416
Mailing Address - Country:US
Mailing Address - Phone:253-572-4750
Mailing Address - Fax:253-272-6666
Practice Address - Street 1:4840 JOURNEY ST SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98513-6779
Practice Address - Country:US
Practice Address - Phone:360-413-2727
Practice Address - Fax:360-455-4620
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60341708101YA0400X
WAMC61443400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)