Healthcare Provider Details

I. General information

NPI: 1841863677
Provider Name (Legal Business Name): ANNA REBECCA MITCHELL RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 TUTOR LN STE 107
EVANSVILLE IN
47715-7295
US

IV. Provider business mailing address

327 MAIN ST APT B
EVANSVILLE IN
47708-2402
US

V. Phone/Fax

Practice location:
  • Phone: 812-602-1038
  • Fax:
Mailing address:
  • Phone: 731-394-6541
  • Fax: 812-822-2496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-85349
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: