Basic Information
Provider Information
NPI: 1700460359
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MITCHEL
FirstName: LINDSAY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: T-LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 271 W 3RD ST N STE 600
Address2:  
City: WICHITA
State: KS
PostalCode: 672021223
CountryCode: US
TelephoneNumber: 3166607600
FaxNumber: 3169415075
Practice Location
Address1: 635 N MAIN ST
Address2:  
City: WICHITA
State: KS
PostalCode: 672033602
CountryCode: US
TelephoneNumber: 3166607525
FaxNumber: 3166601897
Other Information
ProviderEnumerationDate: 05/10/2021
LastUpdateDate: 05/10/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/10/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X03803KSY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


Home