Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | ||
Y | 175F00000X | Naturopath | ||
N | 175L00000X | Homeopath |
NPI | 1356763874 |
---|---|
Provider Name | Mrs. Karla Mitchell |
First Address | Canton, MI 48188-2198 |
Second Address | Detroit, MI 48235-2976 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2014 |
Last Update Date | 17/01/2014 |