Provider Demographics
NPI:1194268615
Name:MITCHELL, JODI (MA)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 W SHAW AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-2600
Mailing Address - Country:US
Mailing Address - Phone:559-460-0715
Mailing Address - Fax:
Practice Address - Street 1:334 W SHAW AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-2600
Practice Address - Country:US
Practice Address - Phone:559-460-0715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93340106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist