Provider Demographics
NPI:1144924721
Name:MIZAUR, CANDACE (PLMHP)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:MIZAUR
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9819 S 168TH AVE STE 6F
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-1154
Mailing Address - Country:US
Mailing Address - Phone:402-807-0228
Mailing Address - Fax:
Practice Address - Street 1:9819 S 168TH AVE STE 6F
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68136-1154
Practice Address - Country:US
Practice Address - Phone:402-807-0228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13287101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health