Provider Demographics
NPI:1013449131
Name:MITCHELL, MATTHEW (MSSA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MSSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7162 READING RD
Mailing Address - Street 2:700
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-3838
Mailing Address - Country:US
Mailing Address - Phone:513-559-1402
Mailing Address - Fax:513-559-5475
Practice Address - Street 1:7162 READING RD
Practice Address - Street 2:700
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-3838
Practice Address - Country:US
Practice Address - Phone:513-559-1402
Practice Address - Fax:513-559-5475
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0700307101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health