MEDICARE: DR. CANDIS 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	PA026	NV

General Provider Information

NPI Number	:	1457766222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CANDIS MITCHELL PSY.D

Provider Business Mailing Address
First Line	:	245 E CENTENNIAL PKWY APT 2071
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-1370
Country	:	US
Telephone Number	:	702-771-8767
Fax Number	:

Provider Business Practice Location Address
First Line	:	4530 S DECATUR BLVD STE 201B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-5239
Country	:	US
Telephone Number	:	702-530-1111
Fax Number	:

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

Provider Enumeration Date	:	06/30/2014
Last Update Date	:	07/22/2025

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