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NPI Code Detail

MEDICARE: MIKAYLA MITCHELL

MEDICARE: MIKAYLA 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 : 1467396655
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKAYLA MITCHELL
Provider Business Mailing Address
First Line : 137 SOMERSBY BLVD
Second Line :
City : POOLER
State : GA
Zip : 31322-9371
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 105 GRAND CENTRAL BLVD STE 101
Second Line :
City : POOLER
State : GA
Zip : 31322-4146
Country : US
Telephone Number : 912-244-3305
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2026
Last Update Date : 05/01/2026

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Directions to “ MIKAYLA MITCHELL ” Practice Location

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