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General NPI Number Information
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NPI Number | 1770933764
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Entity Type | Individual
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Provider Name | CASSANDRA RENEE MITCHELL LMHC
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Gender | Female
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Dates
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Enumeration Date | 06/21/2016
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Last Update Date | 06/21/2016
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Provider Practice Location Address
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Address Line | 5214 4TH AVENUE CIR E
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City | BRADENTON
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State | FL
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Zip | 34208-5621
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Country | US
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Telephone | 941-782-4618
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Fax | 941-782-4642
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Provider Business Mailing Address
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Address Line | PO BOX 9478
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City | BRADENTON
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State | FL
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Zip | 34206-9478
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Country | US
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Telephone | 941-782-4299
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Fax | 941-782-4301
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH124234
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License Number State | FL
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