Provider Demographics
NPI:1255491429
Name:MITCHELL, ELLISON CAPERS JR (PHD)
Entity type:Individual
Prefix:DR
First Name:ELLISON
Middle Name:CAPERS
Last Name:MITCHELL
Suffix:JR
Gender:
Credentials:PHD
Other - Prefix:DR
Other - First Name:ELI ELLISON
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:4877 CHAMBLISS AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5122
Mailing Address - Country:US
Mailing Address - Phone:865-588-1923
Mailing Address - Fax:865-584-7487
Practice Address - Street 1:4877 CHAMBLISS AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5122
Practice Address - Country:US
Practice Address - Phone:865-588-1923
Practice Address - Fax:865-584-7487
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP329103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3688704Medicare UPIN
TN3688704Medicare ID - Type Unspecified