Provider Demographics
NPI:1770653578
Name:MITCHELL, JEAN-MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEAN-MARIE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JEAN
Other - Middle Name:MARIE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4719 QUAIL LAKES DR STE G442
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-8140
Mailing Address - Country:US
Mailing Address - Phone:808-339-0579
Mailing Address - Fax:
Practice Address - Street 1:3252 W MARCH LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-2341
Practice Address - Country:US
Practice Address - Phone:808-339-0579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41328OtherCOUNTY ID