Provider Demographics
NPI:1851069967
Name:MITCHELL, MERRICK GAIL (MA)
Entity Type:Individual
Prefix:
First Name:MERRICK
Middle Name:GAIL
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 34TH AVE NW STE 215
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-7055
Mailing Address - Country:US
Mailing Address - Phone:507-288-5818
Mailing Address - Fax:507-424-1052
Practice Address - Street 1:975 34TH AVE NW STE 215
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-7055
Practice Address - Country:US
Practice Address - Phone:507-288-5818
Practice Address - Fax:507-424-1052
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MNCC03781101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health