Provider Demographics
NPI:1083787709
Name:MITCHELL, WILLIAM A (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:NORTHWEST CENTER FOR BEHAVIORAL HEALTH
Mailing Address - Street 2:1222 10TH STREET, SUITE 211
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-3156
Mailing Address - Country:US
Mailing Address - Phone:580-571-3217
Mailing Address - Fax:580-256-8609
Practice Address - Street 1:NORTHWEST CENTER FOR BEHAVIORAL HEALTH
Practice Address - Street 2:1 MILE EAST ON HIGHWAY 270
Practice Address - City:FORT SUPPLY
Practice Address - State:OK
Practice Address - Zip Code:73841-0001
Practice Address - Country:US
Practice Address - Phone:580-766-2311
Practice Address - Fax:580-766-2017
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK177362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00292169OtherRR MCR
OK100083750AMedicaid
OK$$$$$$$$$OtherFEDERAL TAX I.D. NUMBER
OK100083750AMedicaid
OK$$$$$$$$$OtherFEDERAL TAX I.D. NUMBER
OK238530814Medicare PIN