Healthcare Provider Details

I. General information

NPI: 1649337957
Provider Name (Legal Business Name): JAMES MITCHELL III PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 BUENA VISTA AVE W
SAN FRANCISCO CA
94117-4108
US

IV. Provider business mailing address

PO BOX 591076
SAN FRANCISCO CA
94159-1076
US

V. Phone/Fax

Practice location:
  • Phone: 415-934-6871
  • Fax: 415-863-0622
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number380019BN
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: