Healthcare Provider Details

I. General information

NPI: 1255207411
Provider Name (Legal Business Name): THE MESETA COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CENTER ST
YARMOUTH ME
04096-7929
US

IV. Provider business mailing address

32 CENTER ST
YARMOUTH ME
04096-7929
US

V. Phone/Fax

Practice location:
  • Phone: 858-449-7208
  • Fax:
Mailing address:
  • Phone: 858-847-0234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMANDA ELIZABETH MITCHELL
Title or Position: OWNER, LPCP-C, NCC
Credential:
Phone: 858-449-7208