Provider Demographics
NPI:1629308705
Name:MITCHELL, ELISA LEIGH (MACP, RC)
Entity Type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:LEIGH
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MACP, RC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 164TH ST SW APT 1202
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-3249
Mailing Address - Country:US
Mailing Address - Phone:480-381-4642
Mailing Address - Fax:
Practice Address - Street 1:6523 21ST AVE NE APT 3
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-6924
Practice Address - Country:US
Practice Address - Phone:480-381-4642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00057490101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health