Phylette Nicole Mitchellwillis, LICENSED PSYCHOLOGIS

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

33674 Issued in TX

Practice address

2200 Market St Ste 600
Galveston, TX 77550-1532

Phone

(409) 762-8636

Fax

(409) 762-4185

NPI assigned

Oct 16, 2008

Sex

Female

Sole proprietor

No

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 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

Specialty

Clinical Psychologist

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

CPF SJN Outpatient LLCGroup PAC ID 0749637163, 24 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

91.17 of 100Reported as group

Quality

83.48

Improvement activities

40

Cost

67.52

Medicare enrollment (NPD)

Enrolled

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.

• CPF SJN Outpatient, LLC

  • Clinical Psychologist
  • Houston, TX
  • NPI 1730830001
  Medicare reassignment Care Compare group NPD
• Deer Oaks Geriatric Services P C

  • Clinical Psychologist
  • San Antonio, TX
  • NPI 1134169287
  Medicare reassignment NPD
• Deer Oaks Mental Health Associates PC

  • Clinical Psychologist
  • Las Cruces, NM
  • NPI 1134175763
  NPD (past)

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

{
    "created_epoch": "1224115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224806400000",
    "number": "1972755346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 MARKET ST STE 600",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775501532",
            "telephone_number": "409-762-8636",
            "fax_number": "409-762-4185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 MARKET ST STE 600",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775501532",
            "telephone_number": "409-762-8636",
            "fax_number": "409-762-4185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELLWILLIS",
        "first_name": "PHYLETTE",
        "middle_name": "NICOLE",
        "credential": "LICENSED PSYCHOLOGIS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-16",
        "last_updated": "2008-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "33674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anushah Mirza
• Allison Mitchell
• Lori Mitchell, M.D.
• Matthew Glen Mitchell, MD
• Taylor Eldora Mitchell, PA-C
• Ajay Mitter, MD
• Jordan K. Mixon, MD
• Katie Lee Mixon, MD
• William Lawrence Mize, M.D.
• Navid Moaziniya

• Clinical Psychologist in Galveston, TX
• Providers in Galveston, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2008; 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.