MEDICARE: FREEDA M MITCHELL LMFT

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	106H00000X	Marriage & Family Therapist	778-124	WI
2	106H00000X	Marriage & Family Therapist	202720	TX
3	106H00000X	Marriage & Family Therapist	T1719	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295923365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREEDA M MITCHELL LMFT

Provider Business Mailing Address
First Line	:	405 STATE HIGHWAY 121 BYP STE A250
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-4183
Country	:	US
Telephone Number	:	214-790-7736
Fax Number	:	214-975-2255

Provider Business Practice Location Address
First Line	:	405 STATE HIGHWAY 121 BYP STE A250
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-4183
Country	:	US
Telephone Number	:	414-326-7880
Fax Number	:	214-975-2255

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

Provider Enumeration Date	:	10/13/2007
Last Update Date	:	04/05/2022

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