MEDICARE: MRS. ABIGAIL MARY MITCHELL MA

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
1	101Y00000X	Counselor
2	106H00000X	Marriage & Family Therapist	M.1800091	OH
3	106H00000X	Marriage & Family Therapist	F.2100218	OH

General Provider Information

NPI Number	:	1265960454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ABIGAIL MARY MITCHELL MA

Provider Business Mailing Address
First Line	:	5910 SOM CENTER RD
Second Line	:
City	:	SOLON
State	:	OH
Zip	:	44139-2350
Country	:	US
Telephone Number	:	318-458-3044
Fax Number	:

Provider Business Practice Location Address
First Line	:	3109 MAYFIELD RD STE 204
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1726
Country	:	US
Telephone Number	:	440-591-4366
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2017
Last Update Date	:	04/21/2023

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