Provider Demographics
NPI:1184673220
Name:MITCHELL, DAMON GEORGE (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:DAMON
Middle Name:GEORGE
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MS, LPC
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Mailing Address - Street 1:1926 S GLENSTONE AVE
Mailing Address - Street 2:#220
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2305
Mailing Address - Country:US
Mailing Address - Phone:417-838-8809
Mailing Address - Fax:417-886-1417
Practice Address - Street 1:1926 S GLENSTONE AVE
Practice Address - Street 2:#220
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2305
Practice Address - Country:US
Practice Address - Phone:417-838-8809
Practice Address - Fax:417-886-1417
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2001025958101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional