Provider Demographics
NPI:1881148989
Name:MITCHELL, CHRISTOPHER GERARD (MSW, PHD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:GERARD
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-7129
Mailing Address - Country:US
Mailing Address - Phone:312-996-8509
Mailing Address - Fax:
Practice Address - Street 1:1040 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-7129
Practice Address - Country:US
Practice Address - Phone:312-996-8509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490079531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical