Healthcare Provider Details

I. General information

NPI: 1093623696
Provider Name (Legal Business Name): TEIJA MITCHELL MHCA.MC.70145053
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 E PINE ST
SEATTLE WA
98122-3929
US

IV. Provider business mailing address

2312 3RD AVE UNIT 235
SEATTLE WA
98121-1735
US

V. Phone/Fax

Practice location:
  • Phone: 206-705-8595
  • Fax:
Mailing address:
  • Phone: 515-829-5596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.70145053
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: