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NPI Code Detail

MEDICARE: JENNIFER MITCHELL

MEDICARE: JENNIFER MITCHELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1215307939
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER MITCHELL
Provider Business Mailing Address
First Line : 967 MARTIN LN
Second Line :
City : SEBASTOPOL
State : CA
Zip : 95472-2531
Country : US
Telephone Number : 415-823-1264
Fax Number :
Provider Business Practice Location Address
First Line : 1626 4TH ST
Second Line :
City : SANTA ROSA
State : CA
Zip : 95404-4020
Country : US
Telephone Number : 707-529-8466
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2015
Last Update Date : 11/23/2015

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