Provider Demographics
NPI:1023180270
Name:MITCHELL, SELENA EMILY (LAC, AMFT)
Entity type:Individual
Prefix:MS
First Name:SELENA
Middle Name:EMILY
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LAC, AMFT
Other - Prefix:
Other - First Name:SELENA
Other - Middle Name:EMILY
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT TRAINEE, LAC
Mailing Address - Street 1:PO BOX 2132
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94953-2132
Mailing Address - Country:US
Mailing Address - Phone:415-936-3900
Mailing Address - Fax:
Practice Address - Street 1:727 ENGLISH ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2425
Practice Address - Country:US
Practice Address - Phone:559-288-7889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6452171100000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171100000XOther Service ProvidersAcupuncturist