MEDICARE: NATALIE MITCHEM BCBA

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	1-25-81187

General Provider Information

NPI Number	:	1992446355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE MITCHEM BCBA

Provider Business Mailing Address
First Line	:	200 VALENCIA DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6311
Country	:	US
Telephone Number	:	252-341-4192
Fax Number	:

Provider Business Practice Location Address
First Line	:	1116 20TH STREET SOUTH, 35205
Second Line	:	PMB# 51
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-2612
Country	:	US
Telephone Number	:	205-490-5364
Fax Number	:

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

Provider Enumeration Date	:	04/07/2022
Last Update Date	:	08/18/2025

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