Organization
MITCHELL R GOLDSTEIN, MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MITCHELL ROBERT GOLDSTEIN MD (OWNER)
(574) 532-0153
Entity
Organization
Contact information
Practice address
107 N EDDY ST, SOUTH BEND, IN 46617-2920
(574) 532-0153
(574) 246-1634
Mailing address
107 N EDDY ST, SOUTH BEND, IN 46617-2920
(574) 532-0153
(574) 246-1634
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100346980B
—
IN
Enumeration date
10/14/2010
Last updated
10/18/2010
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