Healthcare Provider Details

I. General information

NPI: 1851372338
Provider Name (Legal Business Name): JENNIFER S MITCHELL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER S SHELDON

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 E CENTER ST SUITE B6
WARSAW IN
46580-2852
US

IV. Provider business mailing address

119 E CENTER ST SUITE B6
WARSAW IN
46580-2852
US

V. Phone/Fax

Practice location:
  • Phone: 574-267-7890
  • Fax: 574-267-7890
Mailing address:
  • Phone: 574-267-7890
  • Fax: 574-267-7890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001513A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: