Provider Demographics
NPI:1205414364
Name:MITCHELL, TASHA JANE (LCSW)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:JANE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:KY
Mailing Address - Zip Code:42211-0312
Mailing Address - Country:US
Mailing Address - Phone:270-522-0627
Mailing Address - Fax:270-522-6732
Practice Address - Street 1:254 MAIN ST
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:KY
Practice Address - Zip Code:42211-9153
Practice Address - Country:US
Practice Address - Phone:270-522-0627
Practice Address - Fax:270-522-6732
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2555811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty