Healthcare Provider Details

I. General information

NPI: 1558886093
Provider Name (Legal Business Name): RITA MITCHELL MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2017
Last Update Date: 08/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 PARK ST
PLAINWELL MI
49080-1655
US

IV. Provider business mailing address

606 LAWRENCE DR
OTSEGO MI
49078-1527
US

V. Phone/Fax

Practice location:
  • Phone: 269-685-9401
  • Fax: 269-685-9403
Mailing address:
  • Phone: 269-377-8373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberCC-XXR480081183
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401007886
License Number StateMI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: