Provider Demographics
NPI:1255207411
Name:THE MESETA COLLECTIVE
Entity type:Organization
Organization Name:THE MESETA COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LPCP-C, NCC
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-449-7208
Mailing Address - Street 1:32 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-7929
Mailing Address - Country:US
Mailing Address - Phone:858-847-0234
Mailing Address - Fax:
Practice Address - Street 1:20 CENTER ST
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-7929
Practice Address - Country:US
Practice Address - Phone:858-449-7208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty