Provider Demographics
NPI:1760365373
Name:MITCHELL, BENJAMIN BRIAN (LPC-IT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:BRIAN
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 STARR AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-1821
Mailing Address - Country:US
Mailing Address - Phone:715-858-4850
Mailing Address - Fax:715-858-4513
Practice Address - Street 1:1000 STARR AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-1821
Practice Address - Country:US
Practice Address - Phone:715-858-4850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-30
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8414-226390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program