Provider Demographics
NPI:1568442135
Name:MITCHELL, JEFFREY RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:RAYMOND
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8312 KASEMAN CT NE
Mailing Address - Street 2:CHILD AND ADOLESCENT BEHAVIORAL HEALTH CLINIC
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7639
Mailing Address - Country:US
Mailing Address - Phone:505-291-5300
Mailing Address - Fax:505-559-6130
Practice Address - Street 1:8312 KASEMAN CT NE
Practice Address - Street 2:PRESBYTERIAN, OUTPATIENT CHILD BH CLINIC
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7639
Practice Address - Country:US
Practice Address - Phone:505-291-5300
Practice Address - Fax:505-559-6130
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207082084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
2017759OtherCIGNA BEHAVIORAL HEALTH
OK100029450AMedicaid
7411192OtherAETNA BEHAVIORAL HEALTH
OKP00063594Medicare PIN
OKE22753Medicare UPIN