Provider Demographics
NPI:1457766222
Name:MITCHELL, CANDIS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CANDIS
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E CENTENNIAL PKWY APT 2071
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-1370
Mailing Address - Country:US
Mailing Address - Phone:702-771-8767
Mailing Address - Fax:
Practice Address - Street 1:7040 LAREDO ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3000
Practice Address - Country:US
Practice Address - Phone:702-331-4874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA026103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical