Provider Demographics
NPI:1902527344
Name:MITCHELL, PAGET SHELDON (AMFT)
Entity Type:Individual
Prefix:
First Name:PAGET
Middle Name:SHELDON
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 REBECCA DR
Mailing Address - Street 2:
Mailing Address - City:PENNGROVE
Mailing Address - State:CA
Mailing Address - Zip Code:94951-9742
Mailing Address - Country:US
Mailing Address - Phone:415-269-8711
Mailing Address - Fax:
Practice Address - Street 1:5025 REBECCA DR
Practice Address - Street 2:
Practice Address - City:PENNGROVE
Practice Address - State:CA
Practice Address - Zip Code:94951-9742
Practice Address - Country:US
Practice Address - Phone:415-269-8711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist