MEDICARE: SHADONNA 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
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1962706143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHADONNA MITCHELL

Provider Business Mailing Address
First Line	:	5817 VENICE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-5020
Country	:	US
Telephone Number	:	323-301-5590
Fax Number	:

Provider Business Practice Location Address
First Line	:	5817 VENICE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-5020
Country	:	US
Telephone Number	:	323-301-5590
Fax Number	:

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

Provider Enumeration Date	:	01/03/2011
Last Update Date	:	01/03/2011

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Directions to “ SHADONNA MITCHELL ” Practice Location

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