# MITCHELL R GOLDSTEIN, MD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700196698
- **Authorized official:** DR. MITCHELL ROBERT GOLDSTEIN MD (OWNER)
- **Authorized official phone:** (574) 532-0153

## Contact information

- **Practice address:** 107 N EDDY ST, SOUTH BEND, IN 46617-2920
- **Practice address phone:** (574) 532-0153
- **Practice address fax:** (574) 246-1634
- **Mailing address:** 107 N EDDY ST, SOUTH BEND, IN 46617-2920
- **Mailing address phone:** (574) 532-0153
- **Mailing address fax:** (574) 246-1634

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YP2500X | Professional Counselor | — | NULL | Yes |
| 101YP2500X | Professional Counselor | — | — | Yes |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |

## Other

- **Enumeration date:** 10/14/2010
- **Last updated:** 10/18/2010