Provider Demographics
NPI:1396381927
Name:MITCHELL, EVA MICHELLE (LPC)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:MICHELLE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:MICHELLE
Other - Last Name:PSENCIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 S 48TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-6683
Mailing Address - Country:US
Mailing Address - Phone:479-750-2020
Mailing Address - Fax:479-434-6248
Practice Address - Street 1:827 W HARVARD ST
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-4013
Practice Address - Country:US
Practice Address - Phone:479-785-4083
Practice Address - Fax:479-434-6248
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
ARA1909133101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR280760719Medicaid