Provider Demographics
NPI:1215799499
Name:MITCHELL, MICHAEL M I (MA, MJ CHILD LAW)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:M
Last Name:MITCHELL
Suffix:I
Gender:M
Credentials:MA, MJ CHILD LAW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 E 103RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-2807
Mailing Address - Country:US
Mailing Address - Phone:773-914-3187
Mailing Address - Fax:
Practice Address - Street 1:235 E 103RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-2807
Practice Address - Country:US
Practice Address - Phone:773-914-3187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health