MEDICARE: MR. WILLIAM JAMES MITCHELL 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	110336	CA

General Provider Information

NPI Number	:	1710455779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM JAMES MITCHELL LMFT

Provider Business Mailing Address
First Line	:	4532 36TH ST APT 6
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-5013
Country	:	US
Telephone Number	:	619-786-0219
Fax Number	:

Provider Business Practice Location Address
First Line	:	2831 CAMINO DEL RIO S STE 201
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3828
Country	:	US
Telephone Number	:	619-786-0219
Fax Number	:

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

Provider Enumeration Date	:	11/07/2018
Last Update Date	:	11/07/2018

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