Provider Demographics
NPI:1982089124
Name:MITCHELL, MELVIN III (RMHCI)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:
Last Name:MITCHELL
Suffix:III
Gender:M
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N ATLANTIC AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-5045
Mailing Address - Country:US
Mailing Address - Phone:321-784-1315
Mailing Address - Fax:
Practice Address - Street 1:3000 N ATLANTIC AVE STE 102
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-5045
Practice Address - Country:US
Practice Address - Phone:321-784-1315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH13746101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health