Healthcare Provider Details

I. General information

NPI: 1477936474
Provider Name (Legal Business Name): GEORGE DOUGLAS MITCHELL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 N SPRING ST
HARRISON AR
72601-2904
US

IV. Provider business mailing address

815 N SPRING ST
HARRISON AR
72601-2904
US

V. Phone/Fax

Practice location:
  • Phone: 870-204-5697
  • Fax: 870-204-5480
Mailing address:
  • Phone: 870-204-5697
  • Fax: 870-280-5145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7963-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: