Provider Demographics
NPI:1366418873
Name:MITCHELL, PATRICK HALLAM (LMSW)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:HALLAM
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 GREEN RD STE 160
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1572
Mailing Address - Country:US
Mailing Address - Phone:517-882-3732
Mailing Address - Fax:517-882-3633
Practice Address - Street 1:2350 GREEN RD STE 160
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-1572
Practice Address - Country:US
Practice Address - Phone:517-882-3732
Practice Address - Fax:517-882-3633
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011149031041C0700X, 104100000X
NYR05837611041C0700X
IL1490237711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD4497Medicare ID - Type Unspecified