Provider Demographics
NPI:1659363604
Name:MITCHELL, GEORGEANN (LCSW)
Entity Type:Individual
Prefix:DR
First Name:GEORGEANN
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-4781
Mailing Address - Country:US
Mailing Address - Phone:903-723-6092
Mailing Address - Fax:903-723-5149
Practice Address - Street 1:111 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-4781
Practice Address - Country:US
Practice Address - Phone:903-723-6092
Practice Address - Fax:903-723-5149
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25775104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0037EFOtherBCBS
TX063863701Medicaid
TX063863701Medicaid