Provider Demographics
NPI:1982754164
Name:MITCHELL, CAROLINE J
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:J
Last Name:MITCHELL
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 1:2414 BLUFFVIEW CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-2604
Mailing Address - Country:US
Mailing Address - Phone:817-233-8703
Mailing Address - Fax:
Practice Address - Street 1:616 W RUSSELL PL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3658
Practice Address - Country:US
Practice Address - Phone:800-257-8715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21144103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86079AOtherBLUE CROSS BLUE SHIELD
TX86143AOtherBLUE CROSS BLUE SHIELD
TX82311PMedicare ID - Type UnspecifiedOTHER COUNTIES
TX86143AOtherBLUE CROSS BLUE SHIELD
TX86079AOtherBLUE CROSS BLUE SHIELD