Provider Demographics
NPI:1427833565
Name:MITCHELL, LANCE EDWARD
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:EDWARD
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106393 HAPPY TRAILS RD
Mailing Address - Street 2:
Mailing Address - City:MCLOUD
Mailing Address - State:OK
Mailing Address - Zip Code:74851-5106
Mailing Address - Country:US
Mailing Address - Phone:916-524-9564
Mailing Address - Fax:
Practice Address - Street 1:106393 HAPPY TRAILS RD
Practice Address - Street 2:
Practice Address - City:MCLOUD
Practice Address - State:OK
Practice Address - Zip Code:74851-5106
Practice Address - Country:US
Practice Address - Phone:916-524-9564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care