Healthcare Provider Details

I. General information

NPI: 1730564097
Provider Name (Legal Business Name): CHRYSTAL MITCHELL MS, LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 AMOCO DR
MOSS POINT MS
39563-9627
US

IV. Provider business mailing address

4770 AMOCO DR
MOSS POINT MS
39563-9627
US

V. Phone/Fax

Practice location:
  • Phone: 228-474-9511
  • Fax:
Mailing address:
  • Phone: 601-528-1527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2400
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: