MEDICARE: GWENDOLYN MITCHELL MA, 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	203270	TX

General Provider Information

NPI Number	:	1518589191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLYN MITCHELL MA, LMFT

Provider Business Mailing Address
First Line	:	PO BOX 690173
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77269-0173
Country	:	US
Telephone Number	:	713-581-0939
Fax Number	:

Provider Business Practice Location Address
First Line	:	13614 FAWCETT DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-2454
Country	:	US
Telephone Number	:	832-217-0191
Fax Number	:

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

Provider Enumeration Date	:	05/17/2020
Last Update Date	:	07/11/2022

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