Provider Demographics
NPI:1104123934
Name:BRAZELL MITCHELL, SONJA
Entity type:Individual
Prefix:MRS
First Name:SONJA
Middle Name:
Last Name:BRAZELL MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 EAST 200 NORTH
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:UT
Mailing Address - Zip Code:84730-0397
Mailing Address - Country:US
Mailing Address - Phone:435-633-0114
Mailing Address - Fax:
Practice Address - Street 1:255 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-2699
Practice Address - Country:US
Practice Address - Phone:435-896-8236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health