Individual
KENNETH CARL MITTEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
6810 CRUMPLER BLVD, SUITE 303, OLIVE BRANCH, MS 38654-1933
(901) 483-9548
(662) 890-0622
Mailing address
4057 FAIRWAY VIEW CIR W, BARTLETT, TN 38135-9124
(901) 384-9732
(662) 890-0622
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
4333
TN
1041C0700X
Clinical Social Worker
Primary
C6918
MS
Other
Enumeration date
07/31/2010
Last updated
08/30/2010
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