Provider Demographics
NPI:1093410334
Name:MITCHELL, MICHAELA LYNN
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:LYNN
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 1:1521 LEATHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WHITE BLUFF
Mailing Address - State:TN
Mailing Address - Zip Code:37187-5316
Mailing Address - Country:US
Mailing Address - Phone:907-602-6735
Mailing Address - Fax:
Practice Address - Street 1:7108 S KANNER HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-7462
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician