Healthcare Provider Details

I. General information

NPI: 1265817555
Provider Name (Legal Business Name): ROXANNE MITCHELL MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 POND RUN
AUBURN HILLS MI
48326-2768
US

IV. Provider business mailing address

162 LOIS LN
MOUNT CLEMENS MI
48043-2243
US

V. Phone/Fax

Practice location:
  • Phone: 248-340-0559
  • Fax:
Mailing address:
  • Phone: 810-335-5029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number6401014385
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401018242
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: