Provider Demographics
NPI:1659334076
Name:MITCHELL, ANGELA DIANE (PHD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DIANE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6043 W INTERSTATE 20
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-1042
Mailing Address - Country:US
Mailing Address - Phone:817-533-0818
Mailing Address - Fax:877-477-0366
Practice Address - Street 1:6043 W INTERSTATE 20
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1042
Practice Address - Country:US
Practice Address - Phone:817-533-0818
Practice Address - Fax:877-477-0366
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32135103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162269807Medicaid
TX162269801Medicaid
TX162269805Medicaid
TX162269806Medicaid
TX162269806Medicaid
TXTXB166000Medicare PIN
TX162269805Medicaid
TXTXB166001Medicare PIN
TX609952Medicare PIN