Healthcare Provider Details

I. General information

NPI: 1992306898
Provider Name (Legal Business Name): JENNIFER ELAINE MITCHELL LPC, CCS, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7444 DEXTER ANN ARBOR RD STE E4
DEXTER MI
48130-1468
US

IV. Provider business mailing address

7444 DEXTER ANN ARBOR RD STE E4
DEXTER MI
48130-1468
US

V. Phone/Fax

Practice location:
  • Phone: 734-274-9196
  • Fax:
Mailing address:
  • Phone: 734-277-4577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401007038
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: