Provider Demographics
NPI:1679250252
Name:MIZE, JACQUELINE (LMHC, ATR-P)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:MIZE
Suffix:
Gender:F
Credentials:LMHC, ATR-P
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:BONDOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2621 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3880
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1259 E STATE ROAD 205
Practice Address - Street 2:
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725-9492
Practice Address - Country:US
Practice Address - Phone:260-248-8176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004570A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health