Provider Demographics
NPI:1982236741
Name:MITCHEL, JOLIN (LPC, CRC)
Entity Type:Individual
Prefix:
First Name:JOLIN
Middle Name:
Last Name:MITCHEL
Suffix:
Gender:M
Credentials:LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 LUSTER AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-1515
Mailing Address - Country:US
Mailing Address - Phone:608-251-4164
Mailing Address - Fax:
Practice Address - Street 1:437 S YELLOWSTONE DR STE 219
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1061
Practice Address - Country:US
Practice Address - Phone:608-251-4164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7104101YM0800X, 101YP2500X
111708225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor