Provider Demographics
NPI:1770237380
Name:MITCHELL, CAILIN MAREE
Entity Type:Individual
Prefix:
First Name:CAILIN
Middle Name:MAREE
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 1:247 YOUNG AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-2766
Mailing Address - Country:US
Mailing Address - Phone:303-350-9294
Mailing Address - Fax:
Practice Address - Street 1:211 E LOGAN ST STE 201
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4883
Practice Address - Country:US
Practice Address - Phone:208-454-1480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8712101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor