Healthcare Provider Details

I. General information

NPI: 1184547309
Provider Name (Legal Business Name): RON MITCHELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 DEPOT HILL RD
BROOMFIELD CO
80020-1068
US

IV. Provider business mailing address

1022 DEPOT HILL RD
BROOMFIELD CO
80020-1068
US

V. Phone/Fax

Practice location:
  • Phone: 720-515-4487
  • Fax: 720-316-6652
Mailing address:
  • Phone: 720-515-4487
  • Fax: 720-316-6652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSW.0009927582
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: