Provider Demographics
NPI:1245060417
Name:MITCHELL, DEJON (RBT)
Entity type:Individual
Prefix:
First Name:DEJON
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12753 PLANK RD APT 8
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:LA
Mailing Address - Zip Code:70714-4946
Mailing Address - Country:US
Mailing Address - Phone:346-260-1847
Mailing Address - Fax:
Practice Address - Street 1:12753 PLANK RD APT 8
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-4946
Practice Address - Country:US
Practice Address - Phone:346-260-1847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-03
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician