Provider Demographics
NPI:1740916055
Name:MITCHELL, COURTNEY SHAE (LPC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:SHAE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 CALVERT CT
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3215
Mailing Address - Country:US
Mailing Address - Phone:817-896-3884
Mailing Address - Fax:
Practice Address - Street 1:8951 CYPRESS WATERS BLVD STE 160
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4784
Practice Address - Country:US
Practice Address - Phone:817-896-3884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88470101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health