Provider Demographics
NPI:1649578857
Name:MITCHELL, KATHY L (LISWS)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:L
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LISWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-2404
Mailing Address - Country:US
Mailing Address - Phone:440-967-7056
Mailing Address - Fax:
Practice Address - Street 1:3260 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-2404
Practice Address - Country:US
Practice Address - Phone:440-967-7056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0007047SUPV1041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical