MEDICARE: MARK MITCHELL LPC

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	101YP2500X	Professional Counselor	2004024006	MO

General Provider Information

NPI Number	:	1720267917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK MITCHELL LPC

Provider Business Mailing Address
First Line	:	900 E LAHARPE ST
Second Line	:
City	:	KIRKSVILLE
State	:	MO
Zip	:	63501-4520
Country	:	US
Telephone Number	:	660-665-1962
Fax Number	:	660-665-3989

Provider Business Practice Location Address
First Line	:	2945 S BRENTWOOD BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-2713
Country	:	US
Telephone Number	:	314-961-6017
Fax Number	:	314-961-6436

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

Provider Enumeration Date	:	10/24/2007
Last Update Date	:	10/24/2007

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Directions to “ MARK MITCHELL LPC” Practice Location

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