Individual
MR. DAVID RICHARD MITCHELL
Active
Individual
MR. DAVID RICHARD MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149-001264
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
049-72097
BLUE SHIELD PROVIDER #
IL
01
—
060-006208
PRO. SERVICE CORP. LIC.#
IL
01
—
149-001264
LCSW
IL
01
—
36-3969618
FEDERAL TAX ID
IL
01
—
L 2080-032716
TRICARE/CHAMPUS
IL
Enumeration date
07/31/2006
Last updated
04/09/2019
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