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General NPI Number Information
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NPI Number | 1861696874
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Entity Type | Individual
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Provider Name | SARA ROSE MITCHELL LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 726 MATHEWS ST
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City | FORT COLLINS
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State | CO
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Zip | 80524-3313
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Country | US
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Telephone | 970-472-0609
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Fax |
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Provider Business Mailing Address
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Address Line | 3570 REVERE CT E
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City | WELLINGTON
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State | CO
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Zip | 80549-1694
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 548
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License Number State | CO
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