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General NPI Number Information
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NPI Number | 1548662638
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Entity Type | Organization
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Legal Business Name | MITCHELL PSYCHOLOGICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 09/19/2014
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Last Update Date | 10/27/2014
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Provider Practice Location Address
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Address Line | 701 W HIGH ST
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City | JEFFERSON CITY
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State | MO
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Zip | 65101-1525
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Country | US
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Telephone | 573-793-2053
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Fax | 573-793-2053
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Provider Business Mailing Address
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Address Line | 54 KINDERHOOK COUNTY RD
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City | BRUMLEY
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State | MO
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Zip | 65017-3531
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Country | US
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Telephone | 573-793-2053
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Fax | 573-793-2053
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL A STONE
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Credential | PSYD
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Telephone | 573-793-2053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 201200144
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License Number State | MO
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