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General NPI Number Information
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NPI Number | 1780102541
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Entity Type | Individual
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Provider Name | KATHERINE JANE MITCHEM BCBA-D
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Gender | Female
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Dates
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Enumeration Date | 08/31/2017
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Last Update Date | 08/31/2017
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Provider Practice Location Address
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Address Line | 827 FAIRMONT RD STE 207
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City | MORGANTOWN
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State | WV
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Zip | 26501-3857
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Country | US
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Telephone | 304-241-5982
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Fax | 304-212-5462
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Provider Business Mailing Address
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Address Line | 27 IMPERIAL WOODS DR
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City | MORGANTOWN
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State | WV
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Zip | 26508-8128
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Country | US
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Telephone | 304-276-2158
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-12-10165
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License Number State | WV
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