Healthcare Provider Details

I. General information

NPI: 1104786938
Provider Name (Legal Business Name): EDWARD MITCHELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 O ST STE C
ARCATA CA
95521-5789
US

IV. Provider business mailing address

2033 LEWIS AVE STE 304
ARCATA CA
95521-5446
US

V. Phone/Fax

Practice location:
  • Phone: 707-497-9335
  • Fax:
Mailing address:
  • Phone: 918-471-7292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: