Provider Demographics
NPI:1093843781
Name:MITCHELL, JOSEPHINE V
Entity Type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:V
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 SPARROW DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5926
Mailing Address - Country:US
Mailing Address - Phone:931-552-9225
Mailing Address - Fax:
Practice Address - Street 1:118 UNION ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5115
Practice Address - Country:US
Practice Address - Phone:931-647-8257
Practice Address - Fax:931-647-2978
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
3747A0650XOtherRESIDENTIAL TREATMENT