Provider Demographics
NPI:1588091946
Name:MITCHELL, LEANNE (DIPL LAC, LMT, ES)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DIPL LAC, LMT, ES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5779 AUTUMN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6745
Mailing Address - Country:US
Mailing Address - Phone:561-267-6464
Mailing Address - Fax:
Practice Address - Street 1:1035 S STATE ROAD 7 STE 315-27
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6134
Practice Address - Country:US
Practice Address - Phone:561-267-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3321171100000X
FLMA53396174400000X
FLFB9732344174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171100000XOther Service ProvidersAcupuncturist