Provider Demographics
NPI:1336319433
Name:MITCHELL, ANNALEISE (MS)
Entity Type:Individual
Prefix:
First Name:ANNALEISE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2932 NW 122ND ST
Mailing Address - Street 2:SUITE 20
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1957
Mailing Address - Country:US
Mailing Address - Phone:405-831-5657
Mailing Address - Fax:405-224-2534
Practice Address - Street 1:2932 NW 122ND ST
Practice Address - Street 2:SUITE 20
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-1957
Practice Address - Country:US
Practice Address - Phone:405-831-5657
Practice Address - Fax:405-224-2534
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK986106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist