Provider Demographics
NPI:1376838854
Name:MITCHELL, ZACK (LPC)
Entity Type:Individual
Prefix:
First Name:ZACK
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18607 UPPER BAY RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-4231
Mailing Address - Country:US
Mailing Address - Phone:806-831-8881
Mailing Address - Fax:
Practice Address - Street 1:18607 UPPER BAY RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-4231
Practice Address - Country:US
Practice Address - Phone:806-831-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67370101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health