Healthcare Provider Details

I. General information

NPI: 1235263419
Provider Name (Legal Business Name): MITCHELL'S PLACE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4778 OVERTON ROAD
BIRMINGHAM AL
35210
US

IV. Provider business mailing address

4778 OVERTON ROAD
BIRMINGHAM AL
35210
US

V. Phone/Fax

Practice location:
  • Phone: 205-957-0294
  • Fax: 205-957-0298
Mailing address:
  • Phone: 205-957-0294
  • Fax: 205-957-0298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DARRELL W FITZGERALD
Title or Position: BILLING DIRECTOR
Credential: CPAR
Phone: 205-957-0294