Provider Demographics
NPI:1518394006
Name:MITCHELL HOPWOOD, MANDY LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:LYNN
Last Name:MITCHELL HOPWOOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MANDY
Other - Middle Name:LYNN
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2007 E QUAIL RUN RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-5059
Mailing Address - Country:US
Mailing Address - Phone:208-365-5445
Mailing Address - Fax:
Practice Address - Street 1:2007 E QUAIL RUN RD
Practice Address - Street 2:SUITE #1
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-5059
Practice Address - Country:US
Practice Address - Phone:208-365-5445
Practice Address - Fax:208-365-6226
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW365461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical