MEDICARE: MRS. DORA DENISE MITCHELL LPC

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	2010032746	MO
2	101YP2500X	Professional Counselor	2010032746	MO

General Provider Information

NPI Number	:	1407164726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DORA DENISE MITCHELL LPC

Provider Business Mailing Address
First Line	:	PO BOX 1091
Second Line	:
City	:	HANNIBAL
State	:	MO
Zip	:	63401-1091
Country	:	US
Telephone Number	:	573-221-2273
Fax Number	:	573-221-1720

Provider Business Practice Location Address
First Line	:	108 N 3RD ST STE 201
Second Line	:
City	:	HANNIBAL
State	:	MO
Zip	:	63401-3518
Country	:	US
Telephone Number	:	573-221-2273
Fax Number	:	573-221-1720

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

Provider Enumeration Date	:	09/21/2010
Last Update Date	:	04/07/2026

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