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NPI Code Detail

MEDICARE: CAILIN MAREE MITCHELL

MEDICARE: CAILIN MAREE 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
1101Y00000XCounselor8712ID

General Provider Information

NPI Number : 1770237380
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAILIN MAREE MITCHELL
Provider Business Mailing Address
First Line : 247 YOUNG AVE
Second Line :
City : NAMPA
State : ID
Zip : 83651-2766
Country : US
Telephone Number : 303-350-9294
Fax Number :
Provider Business Practice Location Address
First Line : 211 E LOGAN ST STE 201
Second Line :
City : CALDWELL
State : ID
Zip : 83605-4883
Country : US
Telephone Number : 208-454-1480
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2022
Last Update Date : 02/11/2022

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Directions to “ CAILIN MAREE MITCHELL ” Practice Location

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