Provider Demographics
NPI:1528805124
Name:KEHN, MITCHELL ROBERT
Entity type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:ROBERT
Last Name:KEHN
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 1:400 W JACKER AVE
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-2350
Mailing Address - Country:US
Mailing Address - Phone:920-954-5973
Mailing Address - Fax:
Practice Address - Street 1:200 QUINCY ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1817
Practice Address - Country:US
Practice Address - Phone:906-481-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2866106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician