Provider Demographics
NPI:1144025313
Name:MITCHELL, JESSICA CAROLINE (MH25099)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:CAROLINE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MH25099
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7035 BABCOCK RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-5830
Mailing Address - Country:US
Mailing Address - Phone:239-287-9631
Mailing Address - Fax:
Practice Address - Street 1:6804 PORTO FINO CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7139
Practice Address - Country:US
Practice Address - Phone:239-239-3075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH25099101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health