MEDICARE: MICHAEL BEN 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
1	101YM0800X	Mental Health Counselor	NCL0004839	CO

General Provider Information

NPI Number	:	1447727227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL BEN MITCHELL

Provider Business Mailing Address
First Line	:	2641 VETERANS HEIGHTS
Second Line	:
City	:	COLORADO SPRINGSQ
State	:	CO
Zip	:	80904
Country	:	US
Telephone Number	:	719-568-2838
Fax Number	:

Provider Business Practice Location Address
First Line	:	6071 E WOODMEN RD STE 320
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-2612
Country	:	US
Telephone Number	:	719-571-9590
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2018
Last Update Date	:	10/30/2018

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