Provider Demographics
NPI:1245646942
Name:MITCHELL, KARMEN THEA (MM, MT-BC)
Entity type:Individual
Prefix:
First Name:KARMEN
Middle Name:THEA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MM, MT-BC
Other - Prefix:
Other - First Name:KARMEN
Other - Middle Name:THEA
Other - Last Name:MORLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BM, BAE
Mailing Address - Street 1:3501 S MASON ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2627
Mailing Address - Country:US
Mailing Address - Phone:970-407-9084
Mailing Address - Fax:
Practice Address - Street 1:3501 S MASON ST
Practice Address - Street 2:UNIT 1
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2627
Practice Address - Country:US
Practice Address - Phone:970-407-9084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10628225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist