1407466220 NPI number — CYNTHIA RENEA MITCHELL MS, LMHC

Table of content: CYNTHIA RENEA MITCHELL MS, LMHC (NPI 1407466220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407466220 NPI number — CYNTHIA RENEA MITCHELL MS, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
CYNTHIA
Provider Middle Name:
RENEA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MITCHELL
Provider Other First Name:
CYNDI
Provider Other Middle Name:
RENEA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, LMHC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1407466220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
514 CHESTNUT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTIC
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50022-1248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-340-6618
Provider Business Mailing Address Fax Number:
712-254-7143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
514 CHESTNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTIC
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50022-1248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-340-6618
Provider Business Practice Location Address Fax Number:
712-254-7143
Provider Enumeration Date:
08/06/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  100723 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100723 . This is a "LMHC (STATE LICENSE)" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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