Healthcare Provider Details

I. General information

NPI: 1649624735
Provider Name (Legal Business Name): MICHAEL RICHARD MITCHEFF PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S RACE ST
MISHAWAKA IN
46544-2032
US

IV. Provider business mailing address

210 S RACE ST
MISHAWAKA IN
46544-2032
US

V. Phone/Fax

Practice location:
  • Phone: 744-046-7555
  • Fax: 883-783-4269
Mailing address:
  • Phone: 574-229-9695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number2002941A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: