Amanda Emily Mitzel, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

3666-C Issued in AR

Practice address

130 E Poplar St Ste Candd
Fayetteville, AR 72703-2532

Phone

(479) 435-6047

Fax

(479) 755-3595

NPI assigned

Jul 29, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Stone Path Counseling, PLC

  • Mental Health Counselor
  • Fayetteville, AR
  • NPI 1023414885
  NPD (past)

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

{
    "created_epoch": "1280361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667779200000",
    "number": "1922312164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 E POPLAR ST STE C&D",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727032532",
            "telephone_number": "479-435-6047",
            "fax_number": "479-755-3595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 E POPLAR ST STE CANDD",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727032532",
            "telephone_number": "479-435-6047",
            "fax_number": "479-755-3595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITZEL",
        "first_name": "AMANDA",
        "middle_name": "EMILY",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-29",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AR",
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "AR",
            "license": "2506-M",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "3666-C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207147719",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elias Mahon Mitchell, MD
• Elizabeth Ashley Mitchell, LPC
• Elizabeth Marie Mitchell, LCSW
• James Eugene Mitchell IV, M.D.
• Shelly Amanda Mitchell, RD
• Whitney Paige Mobley, APRN, FNP-C, FNP-BC
• Jennifer Noelle Moclair, PHARMD, RPH
• Modern Medicine PLLC
• Rachel Anne Modersitzki, DO
• Sophia M Moes, RD

• Clinical Social Worker in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Clinical Social Worker in Arkansas

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