Provider Demographics
NPI:1437494226
Name:MITCHELL, SALENA (MA,LAC,LPC)
Entity Type:Individual
Prefix:
First Name:SALENA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MA,LAC,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 S HANCOCK AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3740
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1795 JET WING DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80916-2332
Practice Address - Country:US
Practice Address - Phone:719-572-6100
Practice Address - Fax:719-572-6089
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0000924101YA0400X
101YP1600X
CONA00703944376K00000X
COLPC.0015870101YP2500X
CO0000924101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No376K00000XNursing Service Related ProvidersNurse's Aide
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional