MEDICARE: TYLER S. MITCHELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1760984413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER S. MITCHELL

Provider Business Mailing Address
First Line	:	6048 BELFIELD CIR
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-6210
Country	:	US
Telephone Number	:	916-704-8992
Fax Number	:

Provider Business Practice Location Address
First Line	:	3960 INDUSTRIAL BLVD STE 600
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-3496
Country	:	US
Telephone Number	:	916-752-8965
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2018
Last Update Date	:	03/03/2025

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