Healthcare Provider Details

I. General information

NPI: 1306163530
Provider Name (Legal Business Name): KIMBERLY ANN MITCHELL M.A., L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 E. FAIRMOUNT AVE.
STATE COLLEGE PA
16801-5315
US

IV. Provider business mailing address

141 E. FAIRMOUNT AVE.
STATE COLLEGE PA
16801-5315
US

V. Phone/Fax

Practice location:
  • Phone: 814-234-3464
  • Fax: 814-237-6646
Mailing address:
  • Phone: 814-234-3464
  • Fax: 814-237-6646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC001665
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: