Provider Demographics
NPI:1558886093
Name:MITCHELL, RITA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 LAWRENCE DR
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MI
Mailing Address - Zip Code:49078-1527
Mailing Address - Country:US
Mailing Address - Phone:269-377-8373
Mailing Address - Fax:
Practice Address - Street 1:319 PARK ST
Practice Address - Street 2:
Practice Address - City:PLAINWELL
Practice Address - State:MI
Practice Address - Zip Code:49080-1655
Practice Address - Country:US
Practice Address - Phone:269-685-9401
Practice Address - Fax:269-685-9403
Is Sole Proprietor?:No
Enumeration Date:2017-08-05
Last Update Date:2017-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICC-XXR480081183101YS0200X
MI6401007886101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool