Provider Demographics
NPI:1972024123
Name:MITCHELL, THOMAS E
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 E PLUM ST
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-1874
Mailing Address - Country:US
Mailing Address - Phone:509-765-9239
Mailing Address - Fax:509-765-4124
Practice Address - Street 1:840 E PLUM ST
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1874
Practice Address - Country:US
Practice Address - Phone:509-765-9239
Practice Address - Fax:509-765-4124
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor