Provider Demographics
NPI:1669842563
Name:MITCHELL, TAYLOR (RYT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 OLD GREENWOOD RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-4547
Mailing Address - Country:US
Mailing Address - Phone:479-755-4120
Mailing Address - Fax:
Practice Address - Street 1:2801 OLD GREENWOOD RD
Practice Address - Street 2:SUITE 11
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4547
Practice Address - Country:US
Practice Address - Phone:479-755-4120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR140495171W00000X
AR026101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)