Healthcare Provider Details

I. General information

NPI: 1336721000
Provider Name (Legal Business Name): JEFFREY THOMAS MITCHELL MA, MS, LPS, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 MALETA LN STE 101
CASTLE ROCK CO
80108-7612
US

IV. Provider business mailing address

757 MALETA LN STE 101
CASTLE ROCK CO
80108-7612
US

V. Phone/Fax

Practice location:
  • Phone: 720-733-8886
  • Fax: 720-733-8894
Mailing address:
  • Phone: 303-396-7049
  • Fax: 720-733-8894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberACC.0006290
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberACC.0006290
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACC.0006290
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberACC.0006290
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: