Provider Demographics
NPI:1538571229
Name:MITCHELL, JESSICA LYNN (BHCM II)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:BHCM II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W MAIN
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-5038
Mailing Address - Country:US
Mailing Address - Phone:580-924-7330
Mailing Address - Fax:580-924-2739
Practice Address - Street 1:1001 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-5038
Practice Address - Country:US
Practice Address - Phone:580-924-7330
Practice Address - Fax:580-924-2739
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200453720AMedicaid