Provider Demographics
NPI:1396044053
Name:MITCHELL, JACINDA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:JACINDA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12764 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-4948
Mailing Address - Country:US
Mailing Address - Phone:702-340-5232
Mailing Address - Fax:
Practice Address - Street 1:1101 FREMONT AVE STE 101
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-5704
Practice Address - Country:US
Practice Address - Phone:702-340-5232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF66708106H00000X
CA99700106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist