Provider Demographics
NPI:1760094700
Name:MITCHELL, EMMA CATHERINE (AMFT)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:CATHERINE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3985 DENVER DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-7891
Mailing Address - Country:US
Mailing Address - Phone:619-890-5687
Mailing Address - Fax:
Practice Address - Street 1:8355 LA MESA BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-9249
Practice Address - Country:US
Practice Address - Phone:619-797-5972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA117436106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist