Provider Demographics
NPI:1386792406
Name:MITCHELL, JOHN WILLIAM (LPC, MHSP)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WILLIAM
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:LPC, MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 POPLAR AVE STE 2897
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38137-4000
Mailing Address - Country:US
Mailing Address - Phone:901-229-8303
Mailing Address - Fax:901-842-9433
Practice Address - Street 1:5100 POPLAR AVE STE 2897
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38137-4000
Practice Address - Country:US
Practice Address - Phone:901-229-8303
Practice Address - Fax:901-842-9433
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000001405101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional