Provider Demographics
NPI:1184178139
Name:MITCHELL, MAEGHAN
Entity type:Individual
Prefix:MRS
First Name:MAEGHAN
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 W CAREFREE HWY STE 1
Mailing Address - Street 2:#339
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3202
Mailing Address - Country:US
Mailing Address - Phone:623-980-3154
Mailing Address - Fax:
Practice Address - Street 1:922 E PAINT YOUR WAGON TRL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-7773
Practice Address - Country:US
Practice Address - Phone:623-980-3154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WALH61031034101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program