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General NPI Number Information
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NPI Number | 1477803492
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Entity Type | Organization
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Legal Business Name | SUSAN E. R. MITCHELL, PSY.D., LLC
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Dates
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Enumeration Date | 09/18/2012
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 430 EXTON CMNS
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City | EXTON
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State | PA
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Zip | 19341-2451
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Country | US
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Telephone | 484-887-0312
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Fax | 267-295-9905
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Provider Business Mailing Address
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Address Line | 430 EXTON CMNS
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City | EXTON
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State | PA
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Zip | 19341-2451
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Country | US
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Telephone | 484-887-0312
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Fax | 267-295-9905
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUSAN E R MITCHELL
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Credential | PSY.D.
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Telephone | 484-887-0312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | PS0009172L
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License Number State | PA
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