Healthcare Provider Details

I. General information

NPI: 1104734375
Provider Name (Legal Business Name): LISA MARIE MITCHELL CLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18697 RAYBURN HWY
PRESQUE ISLE MI
49777-8355
US

IV. Provider business mailing address

18697 RAYBURN HWY
PRESQUE ISLE MI
49777-8355
US

V. Phone/Fax

Practice location:
  • Phone: 810-282-6868
  • Fax:
Mailing address:
  • Phone: 810-282-6868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: