Provider Demographics
NPI:1093016461
Name:MITCHELL, EMORY
Entity Type:Individual
Prefix:
First Name:EMORY
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 S HIGHWAY 69A
Mailing Address - Street 2:P.O. BOX 1498
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-1016
Mailing Address - Country:US
Mailing Address - Phone:918-332-4390
Mailing Address - Fax:918-332-4424
Practice Address - Street 1:7600 S HIGHWAY 69A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-1016
Practice Address - Country:US
Practice Address - Phone:918-332-4390
Practice Address - Fax:918-332-4424
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health