Provider Demographics
NPI:1316813256
Name:MITCHEM, JACOB RYAN
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:RYAN
Last Name:MITCHEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NW ENGLEWOOD RD STE 150
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-4040
Mailing Address - Country:US
Mailing Address - Phone:800-200-2119
Mailing Address - Fax:
Practice Address - Street 1:101 NW ENGLEWOOD RD STE 150
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-4040
Practice Address - Country:US
Practice Address - Phone:800-200-2119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician