Provider Demographics
NPI:1790703932
Name:MITCHELL, LOVELLA SHARON (MA LCPC)
Entity Type:Individual
Prefix:MRS
First Name:LOVELLA
Middle Name:SHARON
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MA LCPC
Other - Prefix:MRS
Other - First Name:L.
Other - Middle Name:SHARON
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA LCPC
Mailing Address - Street 1:10612 W 123RD ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1952
Mailing Address - Country:US
Mailing Address - Phone:913-814-8571
Mailing Address - Fax:913-814-8571
Practice Address - Street 1:10612 W 123RD ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1952
Practice Address - Country:US
Practice Address - Phone:913-814-8571
Practice Address - Fax:913-814-8571
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS132101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS18499013Medicare UPIN