MEDICARE: MS. TERRI L MITCHELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1124376868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERRI L MITCHELL

Provider Business Mailing Address
First Line	:	PO BOX 893219
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73189-3219
Country	:	US
Telephone Number	:	405-464-0077
Fax Number	:

Provider Business Practice Location Address
First Line	:	1309 N STANDISH AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73117-6016
Country	:	US
Telephone Number	:	405-464-0077
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2012
Last Update Date	:	08/28/2012

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Directions to “ MS. TERRI L MITCHELL ” Practice Location

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