Provider Demographics
NPI:1326621541
Name:MITCHEL, ERIN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:
Last Name:MITCHEL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218 N 92ND LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-2051
Mailing Address - Country:US
Mailing Address - Phone:480-289-8787
Mailing Address - Fax:
Practice Address - Street 1:4218 N 92ND LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-2051
Practice Address - Country:US
Practice Address - Phone:480-289-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-09867225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMT-09867OtherARIZONA MASSAGE BOARD