Healthcare Provider Details

I. General information

NPI: 1972039030
Provider Name (Legal Business Name): DAVID MITCHELL LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4260 SE RAINBOWS END
STUART FL
34997-2470
US

IV. Provider business mailing address

4260 SE RAINBOWS END
STUART FL
34997-2470
US

V. Phone/Fax

Practice location:
  • Phone: 772-236-8395
  • Fax:
Mailing address:
  • Phone: 772-236-8395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH11470
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: