Healthcare Provider Details

I. General information

NPI: 1679173827
Provider Name (Legal Business Name): JOANN ELIZABETH MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 TERESA CT SE
RIO RANCHO NM
87124-2382
US

IV. Provider business mailing address

620 TERESA CT SE
RIO RANCHO NM
87124-2382
US

V. Phone/Fax

Practice location:
  • Phone: 505-417-3646
  • Fax:
Mailing address:
  • Phone: 505-417-3646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2023-0079
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: