Provider Demographics
NPI:1063027472
Name:MITCHELL, MARIO JUWAN
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:JUWAN
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 E TROPICANA AVE STE 375
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6520
Mailing Address - Country:US
Mailing Address - Phone:702-909-8900
Mailing Address - Fax:
Practice Address - Street 1:1515 E TROPICANA AVE STE 375
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6520
Practice Address - Country:US
Practice Address - Phone:702-909-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty