MEDICARE: ANGELA DIANE MITCHELL PH.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	103T00000X	Psychologist	32135	TX

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659334076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA DIANE MITCHELL PH.D

Provider Business Mailing Address
First Line	:	6043 W INTERSTATE 20
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-1042
Country	:	US
Telephone Number	:	817-533-0818
Fax Number	:	877-477-0366

Provider Business Practice Location Address
First Line	:	6043 W INTERSTATE 20
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-1042
Country	:	US
Telephone Number	:	817-533-0818
Fax Number	:	877-477-0366

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

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	11/21/2013

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