Individual provider Active NPI

Mitchell Todd, PHD

  • Clinical Child & Adolescent Psychologist
  • Austin, TX
National Provider Identifier
1538901517
Registry record updated Jun 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
40137 Issued in TX
Practice address
4900 Mueller Blvd
Austin, TX 78723-3051
Phone
(512) 324-3315
NPI assigned
Jun 10, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X 40137 TX Primary

Addresses

Primary practice location

4900 Mueller Blvd
Austin, TX 78723-3051

Mailing address

4900 Mueller Blvd
Austin, TX 78723-3051

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241204003762 TX Practitioner - Clinical Psychologist 2163958869 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Tri-County Clinical CurrentSince Oct 1, 2024 Accepting new patients
Tri-County Clinical CurrentSince Oct 1, 2024 Accepting new patients

Locations

6811 Austin Center Blvd
Ste 400
Austin, TX 78731
Phone (512) 494-4000

3501 Mills Ave
Austin, TX 78731
Phone (512) 324-1017

4900 Mueller Blvd
Austin, TX 78723
Phone (512) 324-0165

Interoperability endpoints

  • Direct secure messaging: mitchell.todd.1@8363.direct.athenahealth.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1717977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717977600000",
    "number": "1538901517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 MUELLER BLVD",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787233051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 MUELLER BLVD",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787233051",
            "telephone_number": "512-324-3315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TODD",
        "first_name": "MITCHELL",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-10",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "TX",
            "license": "40137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

Verify at the official NPI Registry.