Provider Demographics
NPI:1477915288
Name:MITCHELL, YLONDA
Entity Type:Individual
Prefix:DR
First Name:YLONDA
Middle Name:
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 1:3430 MCKELVEY ROAD
Mailing Address - Street 2:STE L, PMB 1455
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-9151
Mailing Address - Country:US
Mailing Address - Phone:314-370-2230
Mailing Address - Fax:
Practice Address - Street 1:3430 MCKELVEY ROAD
Practice Address - Street 2:STE L, PMB 1455
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-1600
Practice Address - Country:US
Practice Address - Phone:314-370-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015016676101YP2500X, 101YS0200X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool