Provider Demographics
NPI:1144628785
Name:MITCHELL, THOMAS (LPC, NCC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 W 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2119
Mailing Address - Country:US
Mailing Address - Phone:731-267-2521
Mailing Address - Fax:985-892-3875
Practice Address - Street 1:223 W 28TH AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:731-267-2521
Practice Address - Fax:985-892-3875
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-14
Last Update Date:2019-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7325101YP2500X
TNLPC0000003227101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ022788Medicaid