Healthcare Provider Details

I. General information

NPI: 1639758477
Provider Name (Legal Business Name): CARRIE LOEL MITCHELL HEALTH COACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S BLDG 53
ORANGE CA
92868-3298
US

IV. Provider business mailing address

101 THE CITY DR S BLDG 53
ORANGE CA
92868-3298
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7514
  • Fax: 714-456-2842
Mailing address:
  • Phone: 714-456-7514
  • Fax: 714-456-2842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: