Provider Demographics
NPI:1982307278
Name:MIMMITT, SHYLECIA
Entity type:Individual
Prefix:
First Name:SHYLECIA
Middle Name:
Last Name:MIMMITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 SCRIPTURE ST STE 210
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4343
Mailing Address - Country:US
Mailing Address - Phone:940-220-8491
Mailing Address - Fax:
Practice Address - Street 1:2660 SCRIPTURE ST STE 210
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4343
Practice Address - Country:US
Practice Address - Phone:940-220-8491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1106381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical