Provider Demographics
NPI:1144576968
Name:MITCHEL, ANDREW B (LPC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:B
Last Name:MITCHEL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20700 WATERTOWN RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1800
Mailing Address - Country:US
Mailing Address - Phone:262-782-1474
Mailing Address - Fax:262-782-1441
Practice Address - Street 1:20700 WATERTOWN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1800
Practice Address - Country:US
Practice Address - Phone:262-782-1474
Practice Address - Fax:262-782-1441
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4859-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health