Provider Demographics
NPI:1295608818
Name:MITCHELL, MIESHA LARONDA
Entity type:Individual
Prefix:
First Name:MIESHA
Middle Name:LARONDA
Last Name: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 1:1101 SOVEREIGN ROW
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-1962
Mailing Address - Country:US
Mailing Address - Phone:405-894-0320
Mailing Address - Fax:
Practice Address - Street 1:1101 SOVEREIGN ROW
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-1962
Practice Address - Country:US
Practice Address - Phone:405-894-0320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst