Provider Demographics
NPI:1447984497
Name:MIZELL, LYMAN ALLAN (NBC-HWC)
Entity type:Individual
Prefix:MR
First Name:LYMAN
Middle Name:ALLAN
Last Name:MIZELL
Suffix:
Gender:M
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21074 FIRETOWER RD
Mailing Address - Street 2:
Mailing Address - City:LORANGER
Mailing Address - State:LA
Mailing Address - Zip Code:70446-3654
Mailing Address - Country:US
Mailing Address - Phone:985-474-9582
Mailing Address - Fax:
Practice Address - Street 1:21074 FIRETOWER RD
Practice Address - Street 2:
Practice Address - City:LORANGER
Practice Address - State:LA
Practice Address - Zip Code:70446-3654
Practice Address - Country:US
Practice Address - Phone:985-474-9582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA-3632074171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach