Provider Demographics
NPI:1467004648
Name:MITCHELL, ROBERT LEE JR
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LEE
Last Name:MITCHELL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3326 MATHER FIELD RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-5966
Mailing Address - Country:US
Mailing Address - Phone:916-368-7120
Mailing Address - Fax:916-368-7119
Practice Address - Street 1:3326 MATHER FIELD RD
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-5966
Practice Address - Country:US
Practice Address - Phone:916-368-7120
Practice Address - Fax:916-368-7119
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6310251S00000X
251S00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA251S00000XOtherANGER MANAGEMENT AND 12 STEP CONSULTANT