Provider Demographics
NPI:1912472341
Name:MITCHELL, LISA JEAN (RDN, LD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JEAN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13013 COUNTY ROAD 171
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:77534-9749
Mailing Address - Country:US
Mailing Address - Phone:979-848-7870
Mailing Address - Fax:
Practice Address - Street 1:13013 COUNTY ROAD 171
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:TX
Practice Address - Zip Code:77534-9749
Practice Address - Country:US
Practice Address - Phone:979-848-7870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80790133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered