Jacquelyn Irene Mitchell, MFTI

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

IMF 56335 Issued in CA

Practice address

3049 Darlene LN
Modesto, CA 95355-4157

Phone

(209) 535-1997

NPI assigned

Feb 7, 2013

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

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Marriage and Family Therapist

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sud Specialty Group - CaGroup PAC ID 9537534177, 519 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Sud Specialty Group - Ca

  dba Rula Health

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Santa Clara, CA
  • NPI 1972138238

  Marriage & Family Therapist

  Medicare reassignment Care Compare group NPD
• County of Amador

  • Community/Behavioral Health Agency
  • Sutter Creek, CA
  • NPI 1205055886
  Medicare reassignment NPD
• Cyti Health PC

  dba Cyti Psychological

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • San Diego, CA
  • NPI 1679172290
  Medicare reassignment NPD
• County of Amador

  dba Amador County Behavioral Health SUD

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Sutter Creek, CA
  • NPI 1699321752
  NPD (past)

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

{
    "created_epoch": "1360195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360195200000",
    "number": "1750620902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3049 DARLENE LN",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953554157",
            "telephone_number": "209-535-1997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3049 DARLENE LN",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953554157",
            "telephone_number": "209-535-1997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "JACQUELYN",
        "middle_name": "IRENE",
        "credential": "MFTI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-02-07",
        "last_updated": "2013-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "IMF 56335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anamika Mishra, OTR/L
• James Gareth Misslbeck, MD
• Ashly Rachell Yvette Mitchell
• Dylan Joshua Mitchell
• Emily Jane Mitchell, LMFT
• Jaden Mitchell
• Karen Marie Mitchell, LCSW
• Kyle Mitchell
• Mallory Jane Mitchell, DO
• Rebecca Sheila Mitchell

• Marriage & Family Therapist in Modesto, CA
• Providers in Modesto, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.