Provider Demographics
NPI:1124366786
Name:MITCHELL, CIJI
Entity Type:Individual
Prefix:
First Name:CIJI
Middle Name:
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 1:13626 COTTON RUN
Mailing Address - Street 2:
Mailing Address - City:COVE
Mailing Address - State:TX
Mailing Address - Zip Code:77523-0009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13626 COTTON RUN
Practice Address - Street 2:
Practice Address - City:COVE
Practice Address - State:TX
Practice Address - Zip Code:77523-0009
Practice Address - Country:US
Practice Address - Phone:504-237-7021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67730101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional