Organization Name: | ROBERT C. MITCHELL |
NPI Number: | 1053387258 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROBERT C MITCHELL (OWNER-DIRECTOR) |
Mailing Address: | 1220 S Park Ave Suite D Herrin |
State: | IL US |
Postal Code: | 629484177 |
Phone Number: | 6189881757 |
Fax Number: | 6189881700 |
NPI Enumeration Date: | 02/27/2006 |
NPI Last Update Date: | 07/16/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |