Provider Demographics
NPI:1588461396
Name:MITCHELL, MELIA LANAY
Entity type:Individual
Prefix:
First Name:MELIA
Middle Name:LANAY
Last Name:MITCHELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 S DURANGO DR STE 404
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-4456
Mailing Address - Country:US
Mailing Address - Phone:702-994-6175
Mailing Address - Fax:
Practice Address - Street 1:3130 S DURANGO DR STE 404
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-4456
Practice Address - Country:US
Practice Address - Phone:702-994-6175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician