Cynthia Gail Mitchell, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

20043002A Issued in IN

Practice address

1318 Mishawaka Ave
South Bend, IN 46615-3919

Phone

(574) 204-2935

NPI assigned

Apr 21, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1407812225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 537",
            "city": "NOTRE DAME",
            "state": "IN",
            "postal_code": "465560537",
            "telephone_number": "510-919-8897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1318 MISHAWAKA AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466153919",
            "telephone_number": "574-204-2935"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "55 Hatchetts Hill Rd",
            "address_purpose": "LOCATION",
            "city": "Old Lyme",
            "state": "CT",
            "postal_code": "063711534",
            "country_code": "US",
            "telephone_number": "510-919-8897",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "CYNTHIA",
        "middle_name": "GAIL",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-04-21",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "19946",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20043002A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Quinn Minter IV
• Paul Misch, MD
• Renee Mischler, RD, MS
• Colleen Mismas-Hooley, MD
• Mitchell R Goldstein, MD
• Diana D Mitchell, MA
• Kaity Corliss Mitchell, COTA
• Maddison Anne Mitchell
• Shania Mitchell
• Katherine M Miterko

• Clinical Psychologist in South Bend, IN
• Providers in South Bend, IN by specialty
• Clinical Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.