Provider Demographics
NPI:1265817555
Name:MITCHELL, ROXANNE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 LOIS LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2243
Mailing Address - Country:US
Mailing Address - Phone:810-335-5029
Mailing Address - Fax:
Practice Address - Street 1:1814 POND RUN
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2768
Practice Address - Country:US
Practice Address - Phone:248-340-0559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014385305S00000X
MI6401018242101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI386004868Medicaid