Provider Demographics
NPI:1154647477
Name:TEMPLE, MITCHELL KEVIN (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:KEVIN
Last Name:TEMPLE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 OLD FEDERAL RD
Mailing Address - Street 2:
Mailing Address - City:SHORTER
Mailing Address - State:AL
Mailing Address - Zip Code:36075-3509
Mailing Address - Country:US
Mailing Address - Phone:133-431-8331
Mailing Address - Fax:
Practice Address - Street 1:1680 OLD FEDERAL RD
Practice Address - Street 2:
Practice Address - City:SHORTER
Practice Address - State:AL
Practice Address - Zip Code:36075-3509
Practice Address - Country:US
Practice Address - Phone:133-431-8331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL203106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist