Healthcare Provider Details

I. General information

NPI: 1033344163
Provider Name (Legal Business Name): JESSICA ANN MITCHELL MA, PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 05/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 W CHURCH ST
NEWARK OH
43055-5514
US

IV. Provider business mailing address

581 HEBRON RD
HEATH OH
43056-1402
US

V. Phone/Fax

Practice location:
  • Phone: 740-281-1777
  • Fax: 740-281-1778
Mailing address:
  • Phone: 740-522-4673
  • Fax: 740-522-4673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.0500281
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: