Provider Demographics
NPI:1427648419
Name:FRITZ, MITCHELL JONATHAN (MA, QMHP)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:JONATHAN
Last Name:FRITZ
Suffix:
Gender:M
Credentials:MA, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2697
Mailing Address - Country:US
Mailing Address - Phone:503-554-2390
Mailing Address - Fax:
Practice Address - Street 1:1555 NORTHWAY DR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4555
Practice Address - Country:US
Practice Address - Phone:320-251-1775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist