Provider Demographics
NPI:1336721000
Name:MITCHELL, JEFFREY THOMAS (MA, MS, LPS, LAC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:THOMAS
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MA, MS, LPS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 MALETA LN STE 101
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-7612
Mailing Address - Country:US
Mailing Address - Phone:303-396-7049
Mailing Address - Fax:720-733-8894
Practice Address - Street 1:757 MALETA LN STE 101
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-7612
Practice Address - Country:US
Practice Address - Phone:720-733-8886
Practice Address - Fax:720-733-8894
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC.0006290101YM0800X, 101YP2500X, 101YA0400X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor