Provider Demographics
NPI:1104893106
Name:MITCHELL, MICHAEL CALVIN (LCSW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CALVIN
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:CALVIN
Other - Last Name:SEITZ MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3089 SE WILDLIFE RD
Mailing Address - Street 2:
Mailing Address - City:COWGILL
Mailing Address - State:MO
Mailing Address - Zip Code:64637-8715
Mailing Address - Country:US
Mailing Address - Phone:501-366-5825
Mailing Address - Fax:
Practice Address - Street 1:11501 FINANCIAL CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3715
Practice Address - Country:US
Practice Address - Phone:501-223-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARLCSW2050C104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5H462Medicare UPIN
145C712FMedicare ID - Type Unspecified
P98792Medicare UPIN