Provider Demographics
NPI:1831976562
Name:MESTAS, MITCHELL ALBERT
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:ALBERT
Last Name:MESTAS
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 1:509 E 13TH ST BLDG 509E13TH
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-2940
Mailing Address - Country:US
Mailing Address - Phone:719-546-6666
Mailing Address - Fax:
Practice Address - Street 1:28 MACNAUGHTON RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1731
Practice Address - Country:US
Practice Address - Phone:719-821-5234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)