Provider Demographics
NPI:1649624735
Name:MITCHEFF, MICHAEL RICHARD (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RICHARD
Last Name:MITCHEFF
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S RACE ST
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-2032
Mailing Address - Country:US
Mailing Address - Phone:574-229-9695
Mailing Address - Fax:
Practice Address - Street 1:210 S RACE ST
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-2032
Practice Address - Country:US
Practice Address - Phone:744-046-7555
Practice Address - Fax:883-783-4269
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-15
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2002941A103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist