Provider Demographics
NPI:1548095854
Name:MITCHELL, REILLY (LLMSW)
Entity type:Individual
Prefix:
First Name:REILLY
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 NOB HILL CT APT 3
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5462
Mailing Address - Country:US
Mailing Address - Phone:443-481-7475
Mailing Address - Fax:
Practice Address - Street 1:2020 HOGBACK RD STE 18
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9752
Practice Address - Country:US
Practice Address - Phone:517-481-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851118730101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health