Provider Demographics
NPI:1508641432
Name:MITZLAFF, ELIZABETH (LPCA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MITZLAFF
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 MAIN ST APT 521
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-1761
Mailing Address - Country:US
Mailing Address - Phone:502-541-0100
Mailing Address - Fax:
Practice Address - Street 1:10945 REED HARTMAN HWY
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-2828
Practice Address - Country:US
Practice Address - Phone:513-488-7161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY281814101YM0800X
OHC.2204727101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health