Basic Information
| Provider Information | |||||||||
| NPI: | 1275973703 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITCHELL | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | JOY | ||||||||
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| Credential: | M.S., L.M.F.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 621 W LAKE ST STE 350 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554082952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125479990 | ||||||||
| FaxNumber: | 6519250427 | ||||||||
| Practice Location | |||||||||
| Address1: | 3112 HENNEPIN AVE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554082619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123859605 | ||||||||
| FaxNumber: | 6519250427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2013 | ||||||||
| LastUpdateDate: | 01/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 2155 | MN | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.