Provider Demographics
NPI:1245659036
Name:MITCHELL, BRYAN
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:MITCHELL
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 1:1950 N WALNUT RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-6409
Mailing Address - Country:US
Mailing Address - Phone:702-771-4627
Mailing Address - Fax:702-586-6645
Practice Address - Street 1:1950 N WALNUT RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-6409
Practice Address - Country:US
Practice Address - Phone:702-771-4627
Practice Address - Fax:702-586-6645
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst