Provider Demographics
NPI:1447547781
Name:MITCHELL, COURTNEY RACHAY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:RACHAY
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:RACHAY
Other - Last Name:YINGLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-0497
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:870-347-3492
Practice Address - Street 1:305 RODGERS DR
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-7432
Practice Address - Country:US
Practice Address - Phone:501-203-0857
Practice Address - Fax:501-203-0864
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6304-C104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR208151795Medicaid