Provider Demographics
NPI:1538292966
Name:MITCHELL, RIE ROGERS (PHD)
Entity Type:Individual
Prefix:DR
First Name:RIE
Middle Name:ROGERS
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4503 ALTA TUPELO DR
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-2516
Mailing Address - Country:US
Mailing Address - Phone:818-222-4806
Mailing Address - Fax:818-222-4819
Practice Address - Street 1:23480 PARK SORRENTO
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1306
Practice Address - Country:US
Practice Address - Phone:818-222-4823
Practice Address - Fax:818-222-4819
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4521103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent