Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 20043400B | IN |
NPI | 1114698032 |
---|---|
Provider Name | Amy M Mitchell |
First Address | Noblesville, IN 46060-1473 |
Second Address | Carmel, IN 46032-5323 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2021 |
Last Update Date | 21/09/2021 |