Blake P Mitchell, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

32836 Issued in TX

Practice address

17103 Preston Rd
Suite 288
Dallas, TX 75248-1332

Phone

(214) 629-1389

Fax

(972) 250-0943

NPI assigned

Dec 16, 2005

Last updated

Dec 11, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dean Beckloff, PHD, PA

  • Professional Counselor
  • Dallas, TX
  • NPI 1487857686
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197331200000",
    "number": "1043296544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10311 ASHEBORO ST",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750357025",
            "telephone_number": "972-689-2712",
            "fax_number": "972-250-0943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17103 PRESTON RD",
            "address_2": "SUITE 288",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752481332",
            "telephone_number": "214-629-1389",
            "fax_number": "972-250-0943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "BLAKE",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-16",
        "last_updated": "2007-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "32836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• George James Mitchell-Tapping, M.D.
• Naima Mitchell-Turner, RN
• Aaron Mitchell
• Andrew Mitchell
• Bartley David Mitchell, MD
• Bradley Mitchell
• Brandon Coy Mitchell, CRNA
• Brian G Mitchell, PHARM.D.
• Caitlin Lee Mitchell, PA-C
• Cameron Alexandra Mitchell

• Clinical Psychologist in Dallas, TX
• Providers in Dallas, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.