Basic Information
| Provider Information | |||||||||
| NPI: | 1548778640 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITCHELL | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | MILLER | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 226 W 12TH ST | ||||||||
| Address2: | |||||||||
| City: | CROWLEY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705263657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3385013991 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2448 JOHNSTON ST | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705032756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372337250 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2018 | ||||||||
| LastUpdateDate: | 01/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 13358 | LA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.