Healthcare Provider Details

I. General information

NPI: 1083787709
Provider Name (Legal Business Name): WILLIAM A MITCHELL M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTHWEST CENTER FOR BEHAVIORAL HEALTH 1 MILE EAST ON HIGHWAY 270
FORT SUPPLY OK
73841-0001
US

IV. Provider business mailing address

NORTHWEST CENTER FOR BEHAVIORAL HEALTH 1222 10TH STREET, SUITE 211
WOODWARD OK
73801-3156
US

V. Phone/Fax

Practice location:
  • Phone: 580-766-2311
  • Fax: 580-766-2017
Mailing address:
  • Phone: 580-571-3217
  • Fax: 580-256-8609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number17736
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: