Basic Information
| Provider Information | |||||||||
| NPI: | 1558873554 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITCHELL | ||||||||
| FirstName: | FELICIA | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | MFTI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1786 N WILLOW WOODS DR UNIT D | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928071458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148031736 | ||||||||
| FaxNumber: | 3232610809 | ||||||||
| Practice Location | |||||||||
| Address1: | 24328 VERMONT AVE STE 210 | ||||||||
| Address2: | |||||||||
| City: | HARBOR CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907102300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8186431836 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 101YM0800X | 71657 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.