Provider Demographics
NPI:1407812225
Name:MITCHELL, CYNTHIA GAIL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:GAIL
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 537
Mailing Address - Street 2:
Mailing Address - City:NOTRE DAME
Mailing Address - State:IN
Mailing Address - Zip Code:46556-0537
Mailing Address - Country:US
Mailing Address - Phone:510-919-8897
Mailing Address - Fax:
Practice Address - Street 1:1318 MISHAWAKA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-3919
Practice Address - Country:US
Practice Address - Phone:574-204-2935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19946103TC0700X
IN20043002A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical