Provider Demographics
NPI:1528017175
Name:MITCHELL, DOUGLAS HAIG JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:HAIG
Last Name:MITCHELL
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
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Mailing Address - Street 1:566 E GRANDVIEW ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-3657
Mailing Address - Country:US
Mailing Address - Phone:602-361-1177
Mailing Address - Fax:602-222-6577
Practice Address - Street 1:650 E INDIAN SCHOOL RD
Practice Address - Street 2:CS/122
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1839
Practice Address - Country:US
Practice Address - Phone:602-277-5551
Practice Address - Fax:602-222-6577
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ109561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ10956OtherLCSW