Provider Demographics
NPI:1528329646
Name:MITCHELL, RICHARD EDMUND (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EDMUND
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 RAPTOR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CLANCY
Mailing Address - State:MT
Mailing Address - Zip Code:59634-8545
Mailing Address - Country:US
Mailing Address - Phone:406-616-2503
Mailing Address - Fax:800-480-7615
Practice Address - Street 1:15 RAPTOR RIDGE DR
Practice Address - Street 2:
Practice Address - City:CLANCY
Practice Address - State:MT
Practice Address - Zip Code:59634-8545
Practice Address - Country:US
Practice Address - Phone:406-616-6503
Practice Address - Fax:800-480-7615
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-67970103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)