Provider Demographics
NPI:1376206821
Name:OAKES, MITCHELL T (LMSW)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:T
Last Name:OAKES
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16501 N AMTRUST ST APT 202
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-5294
Mailing Address - Country:US
Mailing Address - Phone:541-216-3390
Mailing Address - Fax:
Practice Address - Street 1:3649 N LAKEHARBOR LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-6913
Practice Address - Country:US
Practice Address - Phone:208-991-4296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID40148101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health