MEDICARE: CHARLIE MITCHELL, PH.D. P.C.

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1437284353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLIE MITCHELL, PH.D. P.C.

Provider Business Mailing Address
First Line	:	288 N IRONWOOD DR
Second Line	:	#110
City	:	APACHE JUNCTION
State	:	AZ
Zip	:	85220-3830
Country	:	US
Telephone Number	:	480-982-2356
Fax Number	:

Provider Business Practice Location Address
First Line	:	288 N IRONWOOD DR
Second Line	:	#110
City	:	APACHE JUNCTION
State	:	AZ
Zip	:	85220-3830
Country	:	US
Telephone Number	:	480-982-2356
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. CHARLIE MITCHELL
Credential	:	PH.D.
Telephone Number	:	480-982-2356

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	02/16/2009

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