Provider Demographics
NPI:1114307188
Name:MITCHELL, JEFFREY L
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
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 1:315 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3509
Mailing Address - Country:US
Mailing Address - Phone:870-425-8642
Mailing Address - Fax:
Practice Address - Street 1:353 E 8TH ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-4423
Practice Address - Country:US
Practice Address - Phone:870-701-5141
Practice Address - Fax:870-701-5177
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1804059101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health