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Individual

CORMICK MITCHELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.A.ED.

Contact information

Practice address
850 KALISTE SALOOM RD, SUITE 117, LAFAYETTE, LA 70508
(337) 234-7109
(337) 234-7898
Mailing address
850 KALISTE SALOOM RD, SUITE 117, LAFAYETTE, LA 70508-4230
(337) 234-7109
(337) 234-7898

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1467745000
NPI
LA
Enumeration date
05/06/2016
Last updated
05/30/2018
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