Individual
MITCHEL JAMES MORTENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AAC
Contact information
Practice address
2204 PACIFIC AVE N, LONG BEACH, WA 98631-3300
(360) 642-3787
Mailing address
2204 PACIFIC AVE N, LONG BEACH, WA 98631-3300
(360) 642-3787
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
WA
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760008783
—
WA
Enumeration date
09/03/2021
Last updated
11/21/2022
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