Healthcare Provider Details

I. General information

NPI: 1003728304
Provider Name (Legal Business Name): TAZHNEA LASHEA MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20700 CIVIC CENTER DR STE 110
SOUTHFIELD MI
48076-4102
US

IV. Provider business mailing address

12610 W OUTER DR
DETROIT MI
48223-3202
US

V. Phone/Fax

Practice location:
  • Phone: 800-385-1035
  • Fax:
Mailing address:
  • Phone: 313-750-1544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: