Provider Demographics
NPI:1720051386
Name:MIZES, JAMES SCOTT (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:SCOTT
Last Name:MIZES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-4265
Mailing Address - Country:US
Mailing Address - Phone:304-685-6062
Mailing Address - Fax:304-581-3201
Practice Address - Street 1:235 HIGH ST
Practice Address - Street 2:SUITE 608
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-5429
Practice Address - Country:US
Practice Address - Phone:304-413-4728
Practice Address - Fax:304-581-3201
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV763103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9202017000Medicaid
WV9202017000Medicaid
WV9202017000Medicaid