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NPI Code Detail

MEDICARE: CHANTELL MARIE MITCHELL

MEDICARE: CHANTELL MARIE MITCHELL
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
1101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000000OTHERLANA

General Provider Information

NPI Number : 1982108536
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHANTELL MARIE MITCHELL
Provider Business Mailing Address
First Line : 2439 MANHATTAN BLVD STE 207
Second Line :
City : HARVEY
State : LA
Zip : 70058-5361
Country : US
Telephone Number : 504-364-8949
Fax Number :
Provider Business Practice Location Address
First Line : 2439 MANHATTAN BLVD STE 207
Second Line :
City : HARVEY
State : LA
Zip : 70058-5361
Country : US
Telephone Number : 504-364-8949
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2018
Last Update Date : 03/20/2018

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Directions to “ CHANTELL MARIE MITCHELL ” Practice Location

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