Provider Demographics
NPI:1568892727
Name:MITCHELL, ALISA DANAE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:DANAE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24189 FALLING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:GENTRY
Mailing Address - State:AR
Mailing Address - Zip Code:72734-9006
Mailing Address - Country:US
Mailing Address - Phone:903-701-6840
Mailing Address - Fax:
Practice Address - Street 1:2940 W SUNSET AVE STE D
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-4974
Practice Address - Country:US
Practice Address - Phone:501-205-4570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MO2022013920101YP2500X
ARP2007034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health