MEDICARE: SARAH 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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1962159970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH MITCHELL

Provider Business Mailing Address
First Line	:	405 S MORRISON RD APT 114
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47304-4016
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2816 COOLIDGE HWY APT 12
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-6807
Country	:	US
Telephone Number	:	586-382-3005
Fax Number	:

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

Provider Enumeration Date	:	03/09/2022
Last Update Date	:	08/17/2025

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