Provider Demographics
NPI:1225706294
Name:MITCHELL, LAURA A (AMFT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 N MURRY ST APT B
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-4070
Mailing Address - Country:US
Mailing Address - Phone:530-821-9767
Mailing Address - Fax:
Practice Address - Street 1:401 E OCEAN AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6828
Practice Address - Country:US
Practice Address - Phone:058-737-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA136677106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist