Healthcare Provider Details

I. General information

NPI: 1306387626
Provider Name (Legal Business Name): ALISON MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W 190TH ST STE 280
GARDENA CA
90248-4305
US

IV. Provider business mailing address

6001 MAIN ST UNIT 1639
ZACHARY LA
70791-5067
US

V. Phone/Fax

Practice location:
  • Phone: 877-515-8113
  • Fax: 877-538-2102
Mailing address:
  • Phone: 225-445-8042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number323798
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: