Provider Demographics
NPI:1114348661
Name:MITCHELL, JEANNIE (LMHC)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 KINGSLEY AVE
Mailing Address - Street 2:SUITE #102
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4850
Mailing Address - Country:US
Mailing Address - Phone:904-375-9679
Mailing Address - Fax:904-579-4781
Practice Address - Street 1:462 KINGSLEY AVE
Practice Address - Street 2:SUITE #102
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4850
Practice Address - Country:US
Practice Address - Phone:904-375-9679
Practice Address - Fax:904-579-4781
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-01
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12193101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health