Provider Demographics
NPI:1083311765
Name:MITCHELL, MAMIE NORA (LMSW)
Entity Type:Individual
Prefix:
First Name:MAMIE
Middle Name:NORA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 W EMMA AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2531
Mailing Address - Country:US
Mailing Address - Phone:208-665-1700
Mailing Address - Fax:208-667-8649
Practice Address - Street 1:915 W EMMA AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2531
Practice Address - Country:US
Practice Address - Phone:208-665-1700
Practice Address - Fax:208-667-8649
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID40834104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker