Provider Demographics
NPI:1669924908
Name:MITCHELL-MOMOH, JANA
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:MITCHELL-MOMOH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 WHITNEY RANCH DR APT 1626
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2546
Mailing Address - Country:US
Mailing Address - Phone:127-437-3856
Mailing Address - Fax:
Practice Address - Street 1:1050 WHITNEY RANCH DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2540
Practice Address - Country:US
Practice Address - Phone:612-743-7385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-03
Last Update Date:2023-09-04
Deactivation Date:2017-11-15
Deactivation Code:
Reactivation Date:2023-09-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant