| Doctor Name: | DR. BRIANA VON MIZENER |
| NPI Number: | 1568894301 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 2866 |
| Business Practice Address: | 1432 E Lee Hwy Loudon, TN - 377746440 |
| Business Phone Number: | 8654588900 |
| Business Fax Number: | 8654588626 |
| Mailing Address: | 1432 E Lee Hwy, LOUDON |
| State: | TN |
| Postal Code: | 377746440 |
| Phone Number: | 8654588900 |
| Fax Number: | 8654588626 |
| NPI Enumeration Date: | 08/03/2013 |
| NPI Last Update Date: | 08/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC2200X |
| License Number: | 2866 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical Child & Adolescent |
| Taxonomy Definition: | |