Provider Demographics
NPI:1811253826
Name:LYKINS, MITCHELL LEE (SUDP)
Entity type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:LEE
Last Name:LYKINS
Suffix:
Gender:M
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 E 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-0220
Mailing Address - Country:US
Mailing Address - Phone:509-795-8334
Mailing Address - Fax:509-795-8304
Practice Address - Street 1:5600 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99212-0220
Practice Address - Country:US
Practice Address - Phone:509-795-8334
Practice Address - Fax:509-795-8304
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60116293101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP60116293Medicaid