Provider Information for 1598356099
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PHILLIP B MITCHELL II LCSW
Sex: Male
NPI: 1598356099
Last Updated: 2024-03-18
Certification Date: 2024-02-21
Certification Date: 2024-02-21
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1598356099 | ||||||||||||||
| Enumeration Date | 2021-01-28 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 620 8TH AVE TERRE HAUTE, IN 47804-2771 United States Phone: 812-231-8323 | Fax: | ||||||||||||||
| Primary Practice Address | 500 8TH AVE TERRE HAUTE, IN 47804-4072 United States Phone: 812-231-8376 | Fax:812-231-8208 | ||||||||||||||
| Secondary Practice Address(es) | 950 N MERIDIAN ST | ||||||||||||||
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