Provider Demographics
NPI:1073225975
Name:MITCHELL, JAHA
Entity Type:Individual
Prefix:
First Name:JAHA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 NE PINE ISLAND RD STE 7E
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-2128
Mailing Address - Country:US
Mailing Address - Phone:239-599-8733
Mailing Address - Fax:239-599-8602
Practice Address - Street 1:1490 NE PINE ISLAND RD STE 7E
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2128
Practice Address - Country:US
Practice Address - Phone:239-599-8733
Practice Address - Fax:239-599-8602
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician