Provider Demographics
NPI:1659363604
Name:MITCHELL, GEORGEANN (LCSW)
Entity type:Individual
Prefix:DR
First Name:GEORGEANN
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 MOODY ST
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-7823
Mailing Address - Country:US
Mailing Address - Phone:903-729-1005
Mailing Address - Fax:
Practice Address - Street 1:1311 MOODY ST
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-7823
Practice Address - Country:US
Practice Address - Phone:903-729-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX257751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0037EFOtherBCBS
TX063863701Medicaid
TX063863701Medicaid