Active NPI
Lynda M Mitchell, LCSW
- Clinical Social Worker
- Bullard, TX
National Provider Identifier
1164520888
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 35162
- Practice address
- 246 County Road 3914
Bullard, TX 75757-6820 - Phone
- (903) 894-6000
- NPI assigned
- Sep 20, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 35162 | TX | Primary |
Addresses
Primary practice location
246 County Road 3914
Bullard, TX 75757-6820
Mailing address
3618 Long Leaf Dr
Tyler, TX 75707
Phone (903) 565-4636
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 173940101 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35162 | TX | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307404800000",
"number": "1164520888",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3618 LONG LEAF DR",
"city": "TYLER",
"state": "TX",
"postal_code": "75707",
"telephone_number": "903-565-4636",
"fax_number": "903-565-4559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "246 COUNTY ROAD 3914",
"city": "BULLARD",
"state": "TX",
"postal_code": "757576820",
"telephone_number": "903-894-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "LYNDA",
"middle_name": "M",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2011-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "35162",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "173940101",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bullard, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.