Provider Demographics
NPI:1942752068
Name:MITCHELL, ROY LEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:LEE
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12920 SUMMERFIELD CROSSING BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7210
Mailing Address - Country:US
Mailing Address - Phone:813-605-9220
Mailing Address - Fax:
Practice Address - Street 1:12920 SUMMERFIELD CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-7210
Practice Address - Country:US
Practice Address - Phone:813-605-9220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY12113103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty