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NPI Code Detail

MEDICARE: DEBRA SUZANNE MITCHELL LCSW

MEDICARE: DEBRA SUZANNE MITCHELL LCSW
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
11041C0700XClinical Social Worker34002330IN
2101YM0800XMental Health Counselor34002330IN

General Provider Information

NPI Number : 1952386500
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBRA SUZANNE MITCHELL LCSW
Provider Business Mailing Address
First Line : 645 S ROGERS ST
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-2353
Country : US
Telephone Number : 812-339-1691
Fax Number : 812-339-8109
Provider Business Practice Location Address
First Line : 645 S ROGERS ST
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-2353
Country : US
Telephone Number : 812-339-1691
Fax Number : 812-339-8109
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2005
Last Update Date : 05/03/2009

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Directions to “ DEBRA SUZANNE MITCHELL LCSW” Practice Location

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