Provider Demographics
NPI:1578830873
Name:MITCHELL, CARLTON D II
Entity Type:Individual
Prefix:MR
First Name:CARLTON
Middle Name:D
Last Name:MITCHELL
Suffix:II
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:CHIP
Other - Middle Name:D
Other - Last Name:MITCHELL
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3418 BATES DRIVE
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533
Mailing Address - Country:US
Mailing Address - Phone:580-736-5709
Mailing Address - Fax:
Practice Address - Street 1:1919 ELK
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533
Practice Address - Country:US
Practice Address - Phone:580-595-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103K00000X1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool