Provider Demographics
NPI:1982844106
Name:MITCHELL, KEVIN MATTHEW (BA)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:MATTHEW
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1937 W CHAPMAN AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2633
Mailing Address - Country:US
Mailing Address - Phone:714-998-3272
Mailing Address - Fax:
Practice Address - Street 1:1937 W CHAPMAN AVE STE 220
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2633
Practice Address - Country:US
Practice Address - Phone:714-998-3272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health