Organization
SELFF RECOVERY COACHING
Active
Other names
Tylie Mitchell, Selff Recovery Coaching
Organization subpart
No
Provider details
NPI number
Authorized official
TYLIE YOLANDER MITCHELL LP-MHC,CASAC (OWNER)
(191) 738-3575
Entity
Organization
Contact information
Practice address
2150 E TREMONT AVE APT 5G, BRONX, NY 10462-5732
(917) 383-5753
Mailing address
2150 E TREMONT AVE APT 5G, BRONX, NY 10462-5732
(917) 383-5753
Taxonomy
Speciality
Code
Description
License number
State
103TP2701X
Group Psychotherapy Psychologist
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18102958-01
18102958-01
NM
01
—
18102958-01
FEE FOR SERVICE
NY
05
—
18102958-01
—
NY
Enumeration date
07/06/2022
Last updated
07/06/2022
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