Provider Demographics
NPI:1205395167
Name:SELL, MITRA (LCSW, LEP)
Entity type:Individual
Prefix:
First Name:MITRA
Middle Name:
Last Name:SELL
Suffix:
Gender:F
Credentials:LCSW, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5570 E BIG SKY LN
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4644
Mailing Address - Country:US
Mailing Address - Phone:714-745-2779
Mailing Address - Fax:
Practice Address - Street 1:5570 E BIG SKY LN
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4644
Practice Address - Country:US
Practice Address - Phone:714-745-2779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP2889103TS0200X
CALCS209021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool