Provider Demographics
NPI:1992541189
Name:MITCHELL, JENNY EMMALINE (PHD)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:EMMALINE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:EM
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:4383 41ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1103
Mailing Address - Country:US
Mailing Address - Phone:410-903-9188
Mailing Address - Fax:
Practice Address - Street 1:4383 41ST ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1103
Practice Address - Country:US
Practice Address - Phone:858-351-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY34503103TB0200X, 103TF0000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily