MEDICARE: ANDREA DORANN 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	101YP2500X	Professional Counselor	71756	TX

General Provider Information

NPI Number	:	1912370933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA DORANN MITCHELL LPC

Provider Business Mailing Address
First Line	:	800 JOSHUA DR
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-8102
Country	:	US
Telephone Number	:	817-247-6717
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 E RENFRO ST STE 200
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-3940
Country	:	US
Telephone Number	:	817-247-6717
Fax Number	:

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

Provider Enumeration Date	:	11/12/2015
Last Update Date	:	11/12/2015

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