Provider Demographics
NPI:1699893594
Name:MITCHELL, OLIVIA J (PHD)
Entity type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:J
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:W
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:393 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-1532
Mailing Address - Country:US
Mailing Address - Phone:949-494-0632
Mailing Address - Fax:
Practice Address - Street 1:200 NEWPORT CENTER DR
Practice Address - Street 2:SUITE 202
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7501
Practice Address - Country:US
Practice Address - Phone:949-497-8563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12382103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical