Provider Demographics
NPI:1578708046
Name:MITCHELL, DAVID ANDREW (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ANDREW
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 N 13TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2591
Mailing Address - Country:US
Mailing Address - Phone:605-366-1334
Mailing Address - Fax:
Practice Address - Street 1:1306 N 13TH ST STE 102
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2591
Practice Address - Country:US
Practice Address - Phone:605-366-1334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE801103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical