Provider Demographics
NPI:1891770863
Name:MITCHELL, JO ANN (PHD)
Entity Type:Individual
Prefix:MRS
First Name:JO ANN
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 N MCCOLL RD
Mailing Address - Street 2:STE A
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-9336
Mailing Address - Country:US
Mailing Address - Phone:956-627-3738
Mailing Address - Fax:956-627-1465
Practice Address - Street 1:711 N MCCOLL RD
Practice Address - Street 2:STE A
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-9336
Practice Address - Country:US
Practice Address - Phone:956-627-3738
Practice Address - Fax:956-627-1465
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-2198103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172146601Medicaid
TX610547Medicare ID - Type Unspecified