Provider Demographics
NPI:1518405349
Name:MITCHELL-IBE, DEBRA (LMSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:MITCHELL-IBE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5102 SOUTHPORT DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-1870
Mailing Address - Country:US
Mailing Address - Phone:469-877-4174
Mailing Address - Fax:214-343-8000
Practice Address - Street 1:5102 SOUTHPORT DR
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-1870
Practice Address - Country:US
Practice Address - Phone:469-877-4174
Practice Address - Fax:214-343-8000
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60929171M00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator