Provider Demographics
NPI:1073671996
Name:BRIMAGE, MITCHELL DON SR (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:DON
Last Name:BRIMAGE
Suffix:SR
Gender:M
Credentials:PMHNP-BC
Other - Prefix:MR
Other - First Name:MITCHELL
Other - Middle Name:DON
Other - Last Name:BRIMAGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:1260 ELLA ST UNIT 8
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4147
Mailing Address - Country:US
Mailing Address - Phone:805-441-3611
Mailing Address - Fax:
Practice Address - Street 1:661 BAY LAUREL PLACE
Practice Address - Street 2:SUITE 3B
Practice Address - City:AVILA BEACH
Practice Address - State:CA
Practice Address - Zip Code:93424
Practice Address - Country:US
Practice Address - Phone:805-459-8232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019766363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health