Provider Demographics
NPI:1992773261
Name:MITCHELL, GEORGE PUTNEY JR
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:PUTNEY
Last Name:MITCHELL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:P
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 963
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:PA
Mailing Address - Zip Code:16851
Mailing Address - Country:US
Mailing Address - Phone:814-238-6380
Mailing Address - Fax:814-238-5923
Practice Address - Street 1:444 E COLLEGE AVE
Practice Address - Street 2:STE 310
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16851
Practice Address - Country:US
Practice Address - Phone:814-238-6380
Practice Address - Fax:814-238-5923
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005164L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMI132725Medicare ID - Type Unspecified