Provider Demographics
NPI:1376047944
Name:MITCHELL, BREEAUNNA M (MA, LPC)
Entity Type:Individual
Prefix:
First Name:BREEAUNNA
Middle Name:M
Last Name:MITCHELL
Suffix:
Gender:F
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 1:1763 ST. RT 60
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-8707
Mailing Address - Country:US
Mailing Address - Phone:419-289-4825
Mailing Address - Fax:419-289-4826
Practice Address - Street 1:1763 ST. RT 60
Practice Address - Street 2:SUITE 120
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-8707
Practice Address - Country:US
Practice Address - Phone:419-289-4825
Practice Address - Fax:419-289-4826
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801577101YM0800X
106S00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician