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NPI Code Detail

MEDICARE: MR. MITCHELL JAMES VON GEMMINGEN MA LPC

MEDICARE: MR. MITCHELL JAMES VON GEMMINGEN MA LPC
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
1101YP2500XProfessional Counselor2005014249MO

General Provider Information

NPI Number : 1396750063
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MITCHELL JAMES VON GEMMINGEN MA LPC
Provider Business Mailing Address
First Line : 2885 W BATTLEFIELD ST
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65807-3952
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1001 LYNCH ST
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63118-1818
Country : US
Telephone Number : 314-535-5600
Fax Number : 314-206-3477
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2006
Last Update Date : 09/05/2025

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