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NPI Code Detail

MEDICARE: BRIANNA MITCHELL

MEDICARE: BRIANNA MITCHELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1356840110
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIANNA MITCHELL
Provider Business Mailing Address
First Line : 3209 HIDY RD NW
Second Line :
City : JEFFERSONVILLE
State : OH
Zip : 43128-1500
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2430 VAN BUREN AVE
Second Line :
City : SPRINGFIELD
State : OH
Zip : 45505-2555
Country : US
Telephone Number : 937-878-8444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2018
Last Update Date : 02/07/2018

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Directions to “ BRIANNA MITCHELL ” Practice Location

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