| Tanya D. Mizell | |
|
3763 17th St Ecorse MI 48229-1339 | |
| (734) 237-7199 | |
| Not Available |
| Full Name | Tanya D. Mizell |
|---|---|
| Speciality | Counselor |
| Location | 3763 17th St, Ecorse, Michigan |
| Authorized Official Name and Position | Tanya D Mizell (LICENSED PROFESSIONAL COUNSELOR/CEO) |
| Authorized Official Contact | 7342377199 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tanya D. Mizell 3763 17th St Ecorse MI 48229-1339 Ph: (734) 237-7199 | Tanya D. Mizell 3763 17th St Ecorse MI 48229-1339 Ph: (734) 237-7199 |
| NPI Number | 1861250490 |
|---|---|
| Provider Enumeration Date | 03/08/2024 |
| Last Update Date | 06/09/2024 |
| Certification Date | 03/10/2024 |
| Medicare PECOS PAC ID | 4688013436 |
|---|---|
| Medicare Enrollment ID | O20240412003648 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861250490 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Tanya D Mizell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1306316724 PECOS PAC ID: 6406295252 Enrollment ID: I20240412003715 |
Cns Hearts Of Love Home Care,llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3734 10th Street, Ecorse, MI 48229 Phone: 734-318-7392 Fax: 313-914-7333 | |
Gateway Community Support Systems,llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 28 Salliotte Rd, Ecorse, MI 48229 Phone: 888-610-2217 Fax: 734-818-1438 |