MEDICARE: CANDICE MITCHELL LMHC

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	101YM0800X	Mental Health Counselor	MH23557	FL

General Provider Information

NPI Number	:	1689267494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE MITCHELL LMHC

Provider Business Mailing Address
First Line	:	1631 DEL PRADO BLVD. S SUITE 300
Second Line	:	#1133
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-7549
Country	:	US
Telephone Number	:	239-789-0971
Fax Number	:

Provider Business Practice Location Address
First Line	:	2656 MARAVAL CT
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-3154
Country	:	US
Telephone Number	:	239-789-0971
Fax Number	:

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

Provider Enumeration Date	:	02/12/2021
Last Update Date	:	04/01/2024

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