Healthcare Provider Details

I. General information

NPI: 1477611879
Provider Name (Legal Business Name): LEATTA ANN MITCHELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 11/09/2024
Certification Date: 11/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4934 APPLEWOOD CREST LN
ROSHARON TX
77583-1079
US

IV. Provider business mailing address

2623 SKYVIEW SHADOWS CT
HOUSTON TX
77047-8113
US

V. Phone/Fax

Practice location:
  • Phone: 409-658-6810
  • Fax:
Mailing address:
  • Phone: 713-434-2389
  • Fax: 713-463-7181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number36489
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: