Healthcare Provider Details

I. General information

NPI: 1689048852
Provider Name (Legal Business Name): HENRY MITCHELL III LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2015
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 TWIN OAKS DR
RACELAND LA
70394-2761
US

IV. Provider business mailing address

157 TWIN OAKS DR
RACELAND LA
70394-2761
US

V. Phone/Fax

Practice location:
  • Phone: 985-537-6823
  • Fax: 985-537-5519
Mailing address:
  • Phone: 985-537-6823
  • Fax: 985-537-5519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6665
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: