| Doctor Name: | KENNETH CARL MITTEN |
| NPI Number: | 1275847337 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | 4333 |
| Business Practice Address: | 6810 Crumpler Blvd Suite 303 Olive Branch, MS - 386541933 |
| Business Phone Number: | 9014839548 |
| Business Fax Number: | 6628900622 |
| Mailing Address: | 4057 Fairway View Cir W, BARTLETT |
| State: | TN |
| Postal Code: | 381359124 |
| Phone Number: | 9013849732 |
| Fax Number: | 6628900622 |
| NPI Enumeration Date: | 07/31/2010 |
| NPI Last Update Date: | 08/30/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 4333 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |