| Doctor Name: | DR. KELLY LEIGH MITCHELL |
| NPI Number: | 1407157316 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | 9303 |
| Business Practice Address: | 11 Chapel Pl Wellesley Hills, MA - 024813130 |
| Business Phone Number: | 7812354950 |
| Business Fax Number: | 7812357176 |
| Mailing Address: | 11 Chapel Pl, WELLESLEY HILLS |
| State: | MA |
| Postal Code: | 024813130 |
| Phone Number: | 7812354950 |
| Fax Number: | 7812357176 |
| NPI Enumeration Date: | 11/09/2010 |
| NPI Last Update Date: | 01/08/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 9303 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |