Healthcare Provider Details

I. General information

NPI: 1669755955
Provider Name (Legal Business Name): STEVEN CARRON MITCHELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 HUGHES WAY STE 100
LONG BEACH CA
90810-1877
US

IV. Provider business mailing address

2116 ARLINGTON AVE
LOS ANGELES CA
90018-1353
US

V. Phone/Fax

Practice location:
  • Phone: 310-221-6336
  • Fax:
Mailing address:
  • Phone: 323-334-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number88372
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number128479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: