Provider Demographics
NPI:1356643696
Name:MITCHELL, JONATHAN STEIN (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:STEIN
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2201
Mailing Address - Street 2:OPEN SKY WILDERNESS THERAPY
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81302-2201
Mailing Address - Country:US
Mailing Address - Phone:970-382-8181
Mailing Address - Fax:970-382-9494
Practice Address - Street 1:466 S. SKYLANE DR.
Practice Address - Street 2:OPEN SKY WILDERNESS THERAPY
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303
Practice Address - Country:US
Practice Address - Phone:970-382-8181
Practice Address - Fax:970-382-9494
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO53421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical