Provider Demographics
NPI:1275973703
Name:MITCHELL, SHARON JOY (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:JOY
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 W LAKE ST STE 350
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2952
Mailing Address - Country:US
Mailing Address - Phone:612-547-9990
Mailing Address - Fax:651-925-0427
Practice Address - Street 1:3112 HENNEPIN AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2619
Practice Address - Country:US
Practice Address - Phone:612-385-9605
Practice Address - Fax:651-925-0427
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2155106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist