Channon Mellisa Mitchell

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

145 N Prairie Ave
Inglewood, CA 90301-1904

Phone

(310) 912-9274

Fax

(323) 545-3156

NPI assigned

Sep 7, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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

• Concise Care Group

  • Case Manager/Care Coordinator
  • Inglewood, CA
  • NPI 1144793068
  NPD Authorized official
• Care Matters Healthcare Inc

  • Case Manager/Care Coordinator
  • Los Angeles, CA
  • NPI 1891279972
  NPD (past) Authorized official
• Care Matters Healthcare Inc

  • Case Manager/Care Coordinator
  • Los Angeles, CA
  • NPI 1982074167
  NPD (past) Authorized official

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

{
    "created_epoch": "1630972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630972800000",
    "number": "1114696937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 N PRAIRIE AVE",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903011904",
            "telephone_number": "310-912-9274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 N PRAIRIE AVE",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903011904",
            "telephone_number": "310-912-9274",
            "fax_number": "323-545-3156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "CHANNON",
        "middle_name": "MELLISA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-07",
        "last_updated": "2021-09-07",
        "certification_date": "2021-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20202008",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mission City Community Network, Inc
• Mission City Community Network, Inc
• Anitha Theresa Mitchell, M.D.
• Beverly A Mitchell
• Bryttany Mitchell
• Tristian E Mitchell, LCSW
• Mobile Medical la LLC
• Sarah Jane Mogel, AGACNP-BC
• Hafsa Ahmed Mohamed
• Mohammad Mehdi Mohammadi, DDS

• Addiction (Substance Use Disorder) Counselor in Inglewood, CA
• Providers in Inglewood, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2021; 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.