Provider Demographics
NPI:1548795776
Name:MITCHELL, KATINA SEIRRA ANDREA (LCSW, LSCSW, RPT)
Entity Type:Individual
Prefix:
First Name:KATINA
Middle Name:SEIRRA ANDREA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSW, LSCSW, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N BROADWAY AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-2324
Mailing Address - Country:US
Mailing Address - Phone:316-444-4980
Mailing Address - Fax:
Practice Address - Street 1:200 N BROADWAY AVE STE 110
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2324
Practice Address - Country:US
Practice Address - Phone:316-444-4980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108070104100000X
KS5086104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker