Provider Demographics
NPI:1639292196
Name:MITCHELL, SANDRA J (LPC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
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:PO BOX 474
Mailing Address - Street 2:
Mailing Address - City:ST. HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-3200
Mailing Address - Country:US
Mailing Address - Phone:503-890-5988
Mailing Address - Fax:
Practice Address - Street 1:161 ST. HELENS STREET
Practice Address - Street 2:
Practice Address - City:ST. HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-3200
Practice Address - Country:US
Practice Address - Phone:503-890-5988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1515101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR123190Medicaid