Provider Demographics
NPI:1922126770
Name:MITCHELL, WILL (LAC)
Entity Type:Individual
Prefix:MR
First Name:WILL
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 LAVACA ST
Mailing Address - Street 2:#202
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1336
Mailing Address - Country:US
Mailing Address - Phone:512-495-9015
Mailing Address - Fax:
Practice Address - Street 1:5750 BALCONES DR
Practice Address - Street 2:STE. 106
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4252
Practice Address - Country:US
Practice Address - Phone:512-495-9015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00544171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist