Provider Demographics
NPI:1013596212
Name:MITCHELL, JAY E (MA, MFT)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:E
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:E
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1641
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-1641
Mailing Address - Country:US
Mailing Address - Phone:509-818-6844
Mailing Address - Fax:
Practice Address - Street 1:110 W CRAWFORD ST STE J
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-5356
Practice Address - Country:US
Practice Address - Phone:509-818-6844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61315505101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor