Basic Information
| Provider Information | |||||||||
| NPI: | 1881191302 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITCHELL | ||||||||
| FirstName: | ELLER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2580 LIN DO CT | ||||||||
| Address2: | |||||||||
| City: | SUMTER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291501832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8039054427 | ||||||||
| FaxNumber: | 8039054431 | ||||||||
| Practice Location | |||||||||
| Address1: | 444 2ND LOOP RD | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295052814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435369674 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2018 | ||||||||
| LastUpdateDate: | 01/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst | 106S00000X | 17-33520 | SC | N |
No ID Information.