Healthcare Provider Details

I. General information

NPI: 1073123345
Provider Name (Legal Business Name): KRISTEN MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3595 SAGAMORE PKWY N STE 5
LAFAYETTE IN
47904-1095
US

IV. Provider business mailing address

8646 GUION RD
INDIANAPOLIS IN
46268-3011
US

V. Phone/Fax

Practice location:
  • Phone: 765-637-8326
  • Fax:
Mailing address:
  • Phone: 317-334-7331
  • Fax: 317-334-7336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: