MEDICARE: DR. CYNTHIA GAIL MITCHELL PSY.D.

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	103TC0700X	Clinical Psychologist	19946	CA
2	103TC0700X	Clinical Psychologist	20043002A	IN

General Provider Information

NPI Number	:	1407812225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA GAIL MITCHELL PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 537
Second Line	:
City	:	NOTRE DAME
State	:	IN
Zip	:	46556-0537
Country	:	US
Telephone Number	:	510-919-8897
Fax Number	:

Provider Business Practice Location Address
First Line	:	1318 MISHAWAKA AVE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46615-3919
Country	:	US
Telephone Number	:	574-204-2935
Fax Number	:

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

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	07/21/2022

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