1982928123 NPI number — MS. MELISSA BUNNELL MITCHELL MSW, LISW

Table of content: MS. MELISSA BUNNELL MITCHELL MSW, LISW (NPI 1982928123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982928123 NPI number — MS. MELISSA BUNNELL MITCHELL MSW, LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
MELISSA
Provider Middle Name:
BUNNELL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LISW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BUNNELL
Provider Other First Name:
MELISSA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LISW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982928123
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23 BOSQUE LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87508-2231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-920-8868
Provider Business Mailing Address Fax Number:
505-466-1029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
914 BACA ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87505-0972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-920-8868
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2010

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: 1041C0700X , with the licence number:  I-3296 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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