Provider Demographics
NPI:1649603895
Name:MIZE, TANDI JEAN (LCSW)
Entity type:Individual
Prefix:
First Name:TANDI
Middle Name:JEAN
Last Name:MIZE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TANDI
Other - Middle Name:JEAN
Other - Last Name:FINCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 SENECA DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-5571
Mailing Address - Country:US
Mailing Address - Phone:405-640-7954
Mailing Address - Fax:
Practice Address - Street 1:420 W FEDERAL ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-3626
Practice Address - Country:US
Practice Address - Phone:405-640-7954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 171M00000X
OK52681041C0700X
OK56281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator