Provider Demographics
NPI:1548662638
Name:MITCHELL PSYCHOLOGICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:MITCHELL PSYCHOLOGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:573-793-2053
Mailing Address - Street 1:54 KINDERHOOK COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:BRUMLEY
Mailing Address - State:MO
Mailing Address - Zip Code:65017-3531
Mailing Address - Country:US
Mailing Address - Phone:573-793-2053
Mailing Address - Fax:573-793-2053
Practice Address - Street 1:701 W HIGH ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-1525
Practice Address - Country:US
Practice Address - Phone:573-793-2053
Practice Address - Fax:573-793-2053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO201200144103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty