Provider Demographics
NPI:1417755141
Name:MITCHELL, MARIO LAVELL (DSS PROFESSIONAL)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:LAVELL
Last Name:MITCHELL
Suffix:
Gender:
Credentials:DSS PROFESSIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 N 86TH ST # 68114
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3505
Mailing Address - Country:US
Mailing Address - Phone:402-813-7110
Mailing Address - Fax:
Practice Address - Street 1:543 N 86TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3505
Practice Address - Country:US
Practice Address - Phone:402-813-7110
Practice Address - Fax:402-813-7110
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE261QD1600X103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities