Provider Demographics
NPI:1437295862
Name:MITCHELL, LIVELL EUGENE
Entity type:Individual
Prefix:MR
First Name:LIVELL
Middle Name:EUGENE
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3336 MISSION RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-2845
Mailing Address - Country:US
Mailing Address - Phone:209-915-5384
Mailing Address - Fax:
Practice Address - Street 1:3336 MISSION RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-2845
Practice Address - Country:US
Practice Address - Phone:209-915-5384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health