Provider Demographics
NPI:1871241604
Name:JONES, MITCHELL ALLEN
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:ALLEN
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17176 E NASSAU PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-3203
Mailing Address - Country:US
Mailing Address - Phone:720-989-0159
Mailing Address - Fax:
Practice Address - Street 1:2121 S BLACKHAWK ST # 101
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1487
Practice Address - Country:US
Practice Address - Phone:720-545-0768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COBACB774271106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician