Provider Demographics
NPI:1407466220
Name:MITCHELL, CYNTHIA RENEA (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:RENEA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:CYNDI
Other - Middle Name:RENEA
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LMHC
Mailing Address - Street 1:514 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-1248
Mailing Address - Country:US
Mailing Address - Phone:712-340-6618
Mailing Address - Fax:712-254-7143
Practice Address - Street 1:514 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-1248
Practice Address - Country:US
Practice Address - Phone:712-340-6618
Practice Address - Fax:712-254-7143
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA100723101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA100723OtherLMHC (STATE LICENSE)