Provider Demographics
NPI:1063790475
Name:MITCHELL, DONALD WILLIS (BCBA)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:WILLIS
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 EAGLE CRST
Mailing Address - Street 2:
Mailing Address - City:BARNHART
Mailing Address - State:MO
Mailing Address - Zip Code:63012-2723
Mailing Address - Country:US
Mailing Address - Phone:314-210-7685
Mailing Address - Fax:573-874-1723
Practice Address - Street 1:1900 EAGLE CRST
Practice Address - Street 2:
Practice Address - City:BARNHART
Practice Address - State:MO
Practice Address - Zip Code:63012-2723
Practice Address - Country:US
Practice Address - Phone:314-210-7685
Practice Address - Fax:573-874-1723
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011008097103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst